Bone regeneration around implants in periodontally compromised patients: A randomized clinical trial of the effect of immediate implant with immediate loading

Background: This 2-year randomized clinical trial compared bone regeneration and esthetic outcome between immediate and conventional loading of dental implants placed immediately after extraction in patients with a history of periodontal disease. Methods: Patients were randomly assigned to receive immediate implants with either immediate loading or conventional loading after 3 months. Both groups received a periodontal flap, tooth extraction, implant placement, allograft bone, and membrane placement. The immediate loading group received a temporary crown. In the conventional loading group primary closure was achieved. All patients were followed up at 3, 6, 12, and 24 months. Evaluation included radiographic bone changes, papillary esthetic outcome, and implant survival rate. Results: Seventy-two patients were recruited into the study. However, 60 patients received immediate implant placement after extraction: 30 with conventional loading and 30 with immediate loading. In the immediate loading group the implant survival rate at 2 years was 96.7%, and themean bone gainwas 1.19mm. The corresponding figures in the conventional loading group were 93.3% and 1 mm. The gain in bone level occurred mainly from baseline to 1 year postoperatively in both groups (P < 0.001). The papilla index decreased from baseline to 1 year in both groups (P < 0.001) and changed only slightly thereafter. There were no significant differences between the two groups in the amount of bone gain or papilla index change during 2 years. Conclusions: Immediate loading of a single implant placed in a fresh extraction site in periodontally compromised patients resulted in similar bone gain and soft tissue esthetic outcomes compared to delayed loading. Primary closure and delayed loading to ensure bone regeneration around implants were not critical in this study.