Clinical, Radiological, and Aesthetic Outcomes after Placement of a Bioactive-Surfaced Implant with Immediate or Delayed Loading in the Anterior Maxilla: 1-Year Retrospective Follow-Up Study

Background: Dental implants have become the standard for replacing missing teeth. However, patients' demands for shorter treatment times and the desire for aesthetics in their results can complicate the rehabilitation process, particularly when poor-quality bone is involved. In order to address these challenges, new methods of treating implant surfaces have been introduced. These methods aim to make the implants superhydrophilic and bioactive, enhancing their functionality and interactions with the surrounding tissues. Aim: The aim of the study was to retrospectively examine the efficacy of a superhydrophilic and bioactive implant for treatment of the edentulous maxillary anterior area. The study also aimed to evaluate whether this improved implant surface, by enhancing the osseointegration processes, could serve as a factor in speeding up the loading protocols. Materials and Methods: For this retrospective study, a total of 13 implants were included: 6 delayed restored implants and 7 immediately loaded implants placed in the anterior maxillary area. Clinical, radiographic, and esthetic outcomes were assessed. Baseline measurements of the insertion torque value (ITV) and stability implant quotient (ISQ) were recorded for all implants. In the early-loaded group, these measurements were also taken 30 days (t30) and 45 days (t45) after the placement of the implant to monitor their changes over time. Marginal bone loss (MBL) was calculated according to the changes in marginal bone level on intraoral X-rays taken at two different time points: at baseline and one year after loading. To evaluate the esthetic results, the pink esthetic score (PES) and the white esthetic score (WES) were assessed. For this evaluation, intraoral photographs were taken one year after implant loading. Results: A total of 7 implants were immediately restored, with a mean ITV of 32.29 & PLUSMN; 9.01 Ncm and a mean ISQ of 72.71 & PLUSMN; 2.81. These implants were placed in a bone environment with a mean density of 410.00 & PLUSMN; 194.42 HU. On the other hand, 6 implants with delayed loading had a mean ITV of 28.50 & PLUSMN; 3.27 Ncm, an ISQ of 67.92 & PLUSMN; 8.43, and a mean bone density of 607.50 & PLUSMN; 140.83 HU. The mean PES and WES after 1 year were, respectively, 8.71 & PLUSMN; 1.89 and 8.57 & PLUSMN; 0.79 for immediate and 8.33 & PLUSMN; 1.36 and 9.17 & PLUSMN; 1.33 for delayed-loaded implants. At 12 months after loading, the immediately loaded group had a MBL of 0.29 & PLUSMN; 0.29 mm, while the delayed-loaded group had a MBL of 0.33 & PLUSMN; 0.25. No statistically significant differences between the two treatment groups were found for any of the evaluated outcomes. Conclusions: Despite the limitations of this study, the obtained results may support the use of a superhydrophilic and bioactive implant surface for implant-prosthetic rehabilitation in critical loading protocols with satisfactory esthetic results.