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This study estimates the prevalence of ITI-defined implant placement protocols and evaluates their impact on marginal bone levels and implant failure.

May 30, 2026Open Access

The implementation of implant placement protocols and their short-term impact on marginal bone levels in the esthetic zone: a retrospective cohort study

Key Points

This study estimates the prevalence of ITI-defined implant placement protocols and evaluates their impact on marginal bone levels and implant failure.
Retrospective chart review of 468 implants placed from 2014 to 2018
Categorization of implants into four placement groups and three loading groups
Measurement of bone levels via periapical radiographs at baseline and 12-month follow-up.
53.2% of implants placed at least 6 months post-extraction and loaded after 2 months
No significant differences in marginal bone levels or implant failure among ITI protocol groups
Implant length positively correlated with marginal bone loss, with Nobel implants showing greater bone loss compared to Straumann.

Abstract

Purpose: This study aimed to estimate the prevalence of International Team for Implantology (ITI)-defined implant placement and loading protocols in the maxillary anterior region.Secondary aims were to assess the impact of different ITI protocols on short-term periimplant marginal bone levels and implant failure following prosthetic loading.Methods: A retrospective chart review was conducted on 468 implants placed in partially edentulous patients at Tufts University School of Dental Medicine between 2014 and 2018.Implant placement was categorized into 4 groups: immediate placement following extraction; placement after 4-8 weeks; placement after 12-16 weeks; and placement after 6 months.Prosthetic loading was categorized into 3 groups: immediate loading within 1 week, loading between 1 week and 2 months, and loading after 2 months.Mesial and distal bone levels were measured on periapical radiographs at baseline after implant placement and at the final visit of a 12-month follow-up period using the AxiUm ruler tool, with adjustments for radiographic distortion.Results: Most implants (53.2%) were placed at least 6 months post-extraction and loaded after more than 2 months.Additionally, 17.5% of implants were placed in fresh extraction sockets but loaded after more than 2 months.No significant differences in short-term marginal bone levels or implant failure were observed among ITI protocol groups.However, mesial and distal bone loss increased by 0.061 mm and 0.066 mm, respectively, for every 1-mm increase in implant length.Furthermore, Nobel implants exhibited significantly greater mesial bone loss (0.336 mm) and distal bone loss (0.262 mm) compared with Straumann implants.Conclusions: Although no significant differences were observed in short-term marginal bone levels and implant failure among protocols, the study suggested that implant length and brand might affect marginal bone loss, but further long-term studies are needed to draw more definitive conclusions and explore additional factors impacting implant success.

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