Influence of Surgical and Prosthetic Techniques on Marginal Bone Loss around Titanium Implants. Part I: Immediate Loading in Fresh Extraction Sockets Antoine N. Berberi, BDS, MSc, PhD, 1 Georges E. Tehini, DDS, MSc, 2 Ziad F. Noujeim, DDS, CES, 3 Alexandre A. Khairallah, BDS, DESS, 4 Moustafa N. Abousehlib, DDS, MSc, PhD, 5,6 & Ziad A. Salameh, DDS, MSc, PhD 3 1 Department of Oral and Maxillofacial Surgery, School of Dentistry, Lebanese University, Beirut, Lebanon 2 Department of Prosthodontics, School of Dentistry, Lebanese University, Beirut, Lebanon 3 Research Department, School of Dentistry, Lebanese University, Beirut, Lebanon 4 Department of Radiology, School of Dentistry, Lebanese University, Beirut, Lebanon 5 Department of Materials Science, ACTA, Amsterdam, The Netherlands 6 Faculty of Dentistry, Department of Materials Science, Alexandria University, Alexandria, Egypt Keywords Marginal bone loss; immediate loading; radiological evaluation; titanium implant. Correspondence Moustafa N. Aboushelib, ACTA – Material Science, Louwesweg 1 Amsterdam 1066 EA, The Netherlands. E-mail: info@aboushelib.org, bluemarline_1@yahoo.com This work received support from a reintegration grant (Grant number 489) provided by the Science and Technology Department Fund. The authors deny any conflicts of interest. Accepted October 22, 2013 doi: 10.1111/jopr.12153 Abstract Purpose: Delayed placement of implant abutments has been associated with peri- implant marginal bone loss; however, long-term results obtained by modifying surgical and prosthetic techniques after implant placement are still lacking. This study aimed to evaluate the marginal bone loss around titanium implants placed in fresh extraction sockets using two loading protocols after a 5-year follow-up period. Material and Methods: A total of 36 patients received 40 titanium implants (Astra Tech) intended for single-tooth replacement. Implants were immediately placed into fresh extraction sockets using either a one-stage (immediate loading by placing an in- terim prosthesis into functional occlusion) or a two-stage prosthetic loading protocol (insertion of abutments after 8 weeks of healing time). Marginal bone levels relative to the implant reference point were evaluated at four time intervals using intraoral radiographs: at time of implant placement, and 1, 3, and 5 years after implant place- ment. Measurements were obtained from mesial and distal surfaces of each implant (α = 0.05). Results: One-stage immediate implant placement into fresh extraction sockets re- sulted in a significant reduction in marginal bone loss (p < 0.002) compared to the traditional two-stage technique. Whereas mesial surfaces remained stable for the 5- year observation period, significant marginal bone loss was observed on distal surfaces of implants after cementation of interim prostheses (p < 0.007) and after 12 months (p < 0.034). Conclusions: Within the limitations of this study, immediate loading of implants placed into fresh extraction sockets reduced marginal bone loss and did not compro- mise the success rate of the restorations. Radiological assessment of bone quality and quantity around dental implants is one of the most important evaluation cri- teria in long-term follow-up studies; however, with regard to marginal bone loss (MBL), most reports present only mean val- ues, while frequency distributions of the data have rarely been described. Only a few long-term studies have addressed this issue from the patient level. 1-9 Several criteria have been proposed for the evaluation of the success of dental implants. A commonly used criterion was suggested by Albrektsson et al 10 and was further revised in 1993. 11 According to the authors, 12 a successful dental implant should sustain less than 1.5 mm of bone loss during the first year in function and less than 0.2 mm annually thereafter. In 1999, Wennstr¨ om and Palmer 13 suggested a modification of the radiological criteria used to assess MBL. They suggested that a maximum bone loss of 2 mm could be accepted over a 5-year period after functional loading of the restoration. The peri-implant tissue or biological width is composed of connective tissue coated by layers of epithelial cells that at- tach to the implant surface, forming the junctional epithelium. 1 Journal of Prosthodontics 00 (2014) 1–7 C  2014 by the American College of Prosthodontists