Influence of loading and drilling on marginal bone loss around implants with a Dynamic Bone Management design: A single-blind, randomised, 12-month clinical trial

Purpose: To evaluate marginal bone loss 6 and 12 months after prosthetic loading of implants with Dynamic Bone Management (Straumann, Basel, Switzerland) through the implementation of different drilling protocols. Materials and methods: A balanced, randomised, single-blind clinical trial was conducted with four parallel experimental arms: immediate loading and under-drilling, immediate loading and complete drilling, early loading and under-drilling, and early loading and complete drilling. Forty-four implants with a Dynamic Bone Management design and with a diameter of 3.75 mm and a length of 10.00 mm were placed in healed mature bone (more than 6 months post-extraction). Results: The mean primary stability achieved was 60.6 +/- 12.2 implant stability quotient, with a range from 21 to 75, and no differences were observed when considering the drilling protocol used, bone type or location. Early loading resulted in a loss of 0.728 mm (standard error 0.212; 95% confidence interval 1.134 to -0.325; t value -3.440), whereas immediate loading did not result in any bone loss. When the interaction between the loading and drilling protocols was studied, performing the complete drilling protocol in conjunction with early implant loading was found to result in lower marginal bone loss, with a marginal bone gain effect of 0.814 mm (standard error 0.283; 95% confidence interval -0.274 to 1.353; t value 2.880). Conclusions: Use of the complete drilling protocol in conjunction with early implant loading resulted in the lowest marginal bone loss at 12 months.