Bone Response and Soft Tissue Changes Around Implants With/Without Abutments Supporting Fixed Partial Dentures: Results From a 3-Year, Prospective, Randomized, Controlled Study

BackgroundDiverging opinions exist regarding rough surface abutment usage, and abutment exclusion effects are unstudied. PurposeThe study aims to: (1) assess tissue response to oxidized or machined abutments or no abutment; and (2) evaluate immediate implant-loading effects. Materials and MethodsIn a 2005-2008 parallel-group randomized, clinical trial, 50 partially edentulous subjects received three Branemark TiUnite (Nobel Biocare (R), Gothenburg, Sweden) implants. Superstructures were attached via abutments (one with a TiUnite surface - AOX, and one with a machine-milled surface - AM) or directly at implant level (IL). Implants were immediately loaded (test) or unloaded for 3 months (control). Postoperative examinations were done up to 3 years. ResultsForty-seven subjects were reexamined after 3 years. Four and two implants were lost in test and control groups, respectively, during the first year. Thereafter, no implant loss occurred (95.7% survival). After 1 year, mean (SEM) peri-implant marginal bone loss (MBL) was 1.33 (0.08) mm (test) and 1.25 (0.08) mm (control). Between 1 and 3 years, a nonsignificant MBL occurred: 0.36 (0.08) mm (test) and 0.33 (0.06) mm (control). Similar MBL was found at IL (1.81 [0.93] mm) and AOX (1.77 [0.14] mm) after 3 years and was significantly lower at AM (1.42 [0.17] mm) than at IL (groups merged); 42% of the implants displayed mucosal bleeding at 3 years and probing pocket depths varied between 2.13 (0.12) mm and 3.62 (0.15) mm, significantly lower buccally. Bleeding on probing (BoP) in minute amounts was found in 30-45% of the sites and abundant BoP at about 20% of the sites. Soft tissue retracted mostly during year 1 and was more pronounced buccally. Regression analyses revealed significant effects from smoking, periodontal disease, abundant BoP, and a low initial implant stability quotient on MBL. ConclusionsNo further significant MBL was found between 1 and 3 years, irrespective of loading protocol. Use of machined abutments may benefit marginal bone stability over time.