Aim: To assess immediately loaded parallel conical connection (Nobel Biocare) implants with platform switch design in the maxillary esthetic zone for soft and hard tissue changes.
Materials and methods: A total of 20 patients (n = 20) underwent prosthetic replacement of the missing maxillary anterior tooth, with an immediately loaded parallel conical connection implant (Noble Biocare, Sweden) having a platform switch design. The size of the implant was 3.75 mm in width and 13 mm in length for all patients and placement followed a standardized surgical protocol. Postoperatively, acrylic provisionalization was done within 48 hours followed by a definitive zirconia prosthesis in the 3rd month. Clinically and radiographically, the implants were evaluated for hard tissue (bone density, implant stability, crestal bone loss) and soft tissue changes (mucosal thickness-MT, sulcus probing depth-PD, bleeding on probing-BOP, width of keratinized gingiva-KG) at baseline till 36 months with follow-up intervals after loading.
Results: All patients showed uneventful healing. The difference in implant stability and density scores was significant (p <0.05*) from baseline to 36 months indicating bone formation and osseointegration of the implant. Bleeding on probing was not observed, and probing depth remained within the acceptable range (≤5 mm) at all time intervals after loading. The marginal bone loss was minimal (≤0.2 mm annually) with the absence of implant mobility and without any peri-implant radiolucency. The thickness of the gingiva (3.47 ± 0.34 mm) and width of keratinized gingiva (2.46 ± 0.39 mm) remained within reasonable limits at the 36th month with acceptable esthetic appearance.
Conclusion: In the present study, immediate loading of Nobel parallel conical connection implant in the maxillary anterior region provided adequate primary stability, minimal marginal bone loss, and increased bone density indicating earlier osseointegration. Decreased probing depth, absence of bleeding on probing, and adequate tissue collar at the neck showed better soft tissue emergence in the esthetic zone. The platform switch design demonstrated promising results and therefore can be used as an alternative to the conventional method.
Clinical significance: The present study results suggest that parallel conical connection implants (Nobel Biocare) with TiUnite surface, built-in platform switch combined with conical connection interface, parallel walled body, tapered apex, and double threads from tip to platform are all designed to provide high primary stability and support immediate function protocol, hence can be used flexibly in different bone densities.
Keywords: Esthetics; Immediate loading protocol; Nobel parallel conical connection implant; Platform switch Prosthesis replacement..