Influence of Laser-lok Surface on Immediate Functional Loading of Implants in Single-tooth Replacement : 3-year Results of a Prospective

Randomized Clinical study on Soft Tissue Response And Esthetics

Authored by - Renzo GaurnieriMaurizio GrandeStefano Ippoliti

IJPRD-vol 35 no 5,2015

Abstract

INTRODUCTION

• Immediate (functional) loading – Application of load by means of occluding or non-occluding restorations within 48 hrs. However ,because applied load is reduced or even absent in single tooth replacement ,it has been proposed to use the term ‘immediate function’ rather than ‘immediate loading’ .

• LASER LOK – Implant with a dual bioaffinity collar , consisting of 2 types of microtexturing grooves (8 µm & 10 µm)patented by biohorizon.

AIM

To compare the clinical and esthetic outcome of immediate nonocclusal loading ,using 2 different implants, Laser-Lok(LL) & non-Laser lok (NLL) to replace missing anterior teeth.

Objectives

1) Evaluate and compare implant survival.2) Compare radiographic marginal bone level

changes.3) Volume of interproximal papilla using papilla

index.4) Compare Plaque scores (modified P.I).5) Compare BOP (mod sulcus bleeding index).6) Width of attached mucosa.7) Probing depth.

Research hypothesis

• Laser microtexturing collar surface on the implant neck may influence aesthetic outcomes and soft tissue responses using an immediate loading protocol.

Materials and methods

• Randomized prospective clinical trial.• Approved by university of Naples , Italy.• Duration JAN 2008 - DEC 2012.

• Study group – 78 implants in 77 patients. 36 males, 41 females .• Age range - 45 to 65 years (mean 49.3 yrs).• Single tooth rehabilitation – anterior to middle

maxilla/mandible.• Control group – (NLL) 39 implants.• Test group – (LL) 39 implants.

Inclusion criteria

1. No contraindications for treatment .eg systemic diseases, pregnancy , regular use of prescription medication.

2. Single tooth loss.3. Implant site > 3 months ,post extraction.4. Adjacent teeth – no / treated dental problems.5. Bone height – min 9mm & bone width - 3.8mm6. Torque – 35Ncm

Exclusion criteria

1. Non compensated diseases.2. Poor oral hygiene .3. Smoking > 10 per day.

Implants•2 different implants used (NLL) & (LL).•Both implants had same design and same surface treated with resorbable blast media.

Operative procedures

SURGERY:• One stage surgical approach.• Full thickness flap with minimal extended

release.• Final torque – 35Ncm.• Bone quality was assessed using Lekholm & Zarb

criteria. In presense of type 3 to 4 bone type underpreparation was done using thinner bur.

IMPLANT LOADING• Sterile impression transfers were connected

and flaps were sutured where needed.• Impressions were taken using open tray with

impregum and jaw relation was recorded.• Temporary acrylic crowns were fabricated the

same day and cemented with temporary cement.

Medication and post operative care•Anagesic – Ibuprofen 600 mg immediatly after surgery and 8 hrs.•Antibiotic – Amoxicillin/ clavulanic acid 1gm twice daily for 7 days.• Chlorhexidine digluconate solution 0.12 % rinse twice daily for 1 week.•Sutures left in place for 10 days .

Assessment

RADIOGRAPHIC EXAMINATION • Periapical radiographs with long cone technique

taken 1. At implant surgery 2. After temporary crown placement3. After 1 , 2 and 3 years respectively.

• Radiographs were digitalized using a dedicated scanner (HP3000) and converted into .jpg

Aesthetic assesment• Digital photographs were used to determine

the pink esthetic score.(PES)• Photos were take at baseline and after 3

years.• Finepix pro camera(fujifilm) was used

Data analysisData collected was analysed using : 1. t tests.2.Mann-whitney test3.Friedman test4.Wilcoxon signed-rank test5.Chi square test.

78 implants

Maxilla – 42(22 LL, 20 NLL)

Mandible- 36(17 LL, 19 NLL)

RESULTS

Papilla index score Bleeding Index score

Papilla fill for –1. Laser lok2. Non Laser lokAt baseline, 1,2 & 3 years

Marginal bone loss

PES

Discussion

• Several studies- bone retention elements such as microthreads & grooves at the implant neck stabilize marginal bone loss

• Fibroblasts show better orientation, spreading & channelized growth on microgrooved surfaces, while on non grooved surfaces, they show random growth.

Scanning electron microscope image of 1.Laser microtextured implant collar surface2.Resorbable blast textured implant collar surface

Laser lok Non laser lok

• Laser microtextured surface – attract physical connective tissue attachment .

• Connective tissue fibres orient in a perpendicular direction to the implant surface – Act as seal to apical migration of gingival epithelial cells.

• Reduced epithlial downgrowth.• Greater soft tissue support because of lesser

marginal bone loss.

Conclusion

1. Immediate functional loading of implants in single tooth replacements in the esthetic zone maybe considered valuable and predictable option .

2. Laser Lok implants for Immediate functional loading in the esthetic zone provide better results than the non laser lok implants.

Strengths

1. Title – explanatory and complete.2. Study design- its a prospective and randomized

clinical trial. Outcome measure were clearly defined . Well explained procedures.

3. Material and methods – Standardization of radiographs done using customized silicone stents and film holders

4. Caliberation of examiners – done 5. Extensive range of clinical and radiographic

parameters studied over long duration .

Weakness

1. Larger sample size .2. Longer follow-up duration .

LaserLok Technology Animation.mp4