This study compared the clinical outcomes of immediate loading of dental implants with a Laser-Lok surface vs a non-Laser-Lok surface for single tooth replacements over 3 years. It found that the Laser-Lok implants showed less marginal bone loss, better papilla fill, and higher pink esthetic scores compared to non-Laser-Lok implants. The Laser-Lok surface's microgrooves were found to better orient fibroblast growth and provide more soft tissue support, resulting in reduced epithelial downgrowth and greater clinical success for immediate loading in the esthetic zone.

1. Influence of Laser-lok Surface on
Immediate Functional Loading of
Implants in Single-tooth
Replacement : 3-year Results of a
Prospective Randomized Clinical
study on Soft Tissue Response And
Esthetics
Authored by - Renzo Gaurnieri
Maurizio Grande
Stefano Ippoliti
IJPRD-vol 35 no 5,2015

2. Abstract

3. INTRODUCTION
• Immediate (functional) loading – Application of load by means
of occluding or non-occluding restorations within 48 hrs.
However ,because applied load is reduced or even absent in
single tooth replacement ,it has been proposed to use the
term ‘immediate function’ rather than ‘immediate loading’ .
• LASER LOK – Implant with a dual bioaffinity collar , consisting
of 2 types of microtexturing grooves (8 µm & 10 µm)patented
by biohorizon.

4. AIM
To compare the clinical and esthetic outcome of
immediate nonocclusal loading ,using 2 different
implants, Laser-Lok(LL) & non-Laser lok (NLL) to
replace missing anterior teeth.

5. Objectives
1) Evaluate and compare implant survival.
2) Compare radiographic marginal bone level
changes.
3) Volume of interproximal papilla using papilla
index.
4) Compare Plaque scores (modified P.I).
5) Compare BOP (mod sulcus bleeding index).
6) Width of attached mucosa.
7) Probing depth.

6. Research hypothesis
• Laser microtexturing collar surface on the
implant neck may influence aesthetic
outcomes and soft tissue responses using an
immediate loading protocol.

7. Materials and methods
• Randomized prospective clinical trial.
• Approved by university of Naples , Italy.
• Duration JAN 2008 - DEC 2012.

8. • Study group – 78 implants in 77 patients.
36 males, 41 females .
• Age range - 45 to 65 years (mean 49.3 yrs).
• Single tooth rehabilitation – anterior to middle
maxilla/mandible.
• Control group – (NLL) 39 implants.
• Test group – (LL) 39 implants.

9. Inclusion criteria
1. No contraindications for treatment .eg systemic
diseases, pregnancy , regular use of prescription
medication.
2. Single tooth loss.
3. Implant site > 3 months ,post extraction.
4. Adjacent teeth – no / treated dental problems.
5. Bone height – min 9mm & bone width - 3.8mm
6. Torque – 35Ncm

10. Exclusion criteria
1. Non compensated diseases.
2. Poor oral hygiene .
3. Smoking > 10 per day.

11. Implants
•2 different implants used
(NLL) & (LL).
•Both implants had same
design and same surface
treated with resorbable
blast media.

12. Operative procedures
SURGERY:
• One stage surgical approach.
• Full thickness flap with minimal extended
release.
• Final torque – 35Ncm.
• Bone quality was assessed using Lekholm &
Zarb criteria. In presense of type 3 to 4 bone
type underpreparation was done using thinner
bur.

13. IMPLANT LOADING
• Sterile impression transfers were connected
and flaps were sutured where needed.
• Impressions were taken using open tray with
impregum and jaw relation was recorded.
• Temporary acrylic crowns were fabricated the
same day and cemented with temporary
cement.

14. Medication and post operative care
•Anagesic – Ibuprofen 600 mg immediatly after
surgery and 8 hrs.
•Antibiotic – Amoxicillin/ clavulanic acid 1gm twice
daily for 7 days.
• Chlorhexidine digluconate solution 0.12 % rinse
twice daily for 1 week.
•Sutures left in place for 10 days .

15. Assessment
RADIOGRAPHIC EXAMINATION
• Periapical radiographs with long cone technique
taken
1. At implant surgery
2. After temporary crown placement
3. After 1 , 2 and 3 years respectively.
• Radiographs were digitalized using a dedicated
scanner (HP3000) and converted into .jpg

16. Aesthetic assesment
• Digital photographs were used to determine
the pink esthetic score.(PES)
• Photos were take at baseline and after 3
years.
• Finepix pro camera(fujifilm) was used

17. Data analysis
Data collected was analysed using :
1. t tests.
2.Mann-whitney test
3.Friedman test
4.Wilcoxon signed-rank test
5.Chi square test.

18. 78 implants
Maxilla – 42
(22 LL, 20 NLL)
Mandible- 36
(17 LL, 19 NLL)
RESULTS

19. Papilla index score Bleeding Index score

21. Papilla fill for –
1. Laser lok
2. Non Laser lok
At baseline, 1,2 & 3 years

22. Marginal bone loss

23. PES

25. Discussion
• Several studies- bone retention elements such
as microthreads & grooves at the implant neck
stabilize marginal bone loss
• Fibroblasts show better orientation, spreading
& channelized growth on microgrooved
surfaces, while on non grooved surfaces, they
show random growth.

26. Scanning electron microscope image of
1.Laser microtextured implant collar surface
2.Resorbable blast textured implant collar surface
Laser lok Non laser lok

27. • Laser microtextured surface – attract physical
connective tissue attachment .
• Connective tissue fibres orient in a
perpendicular direction to the implant surface
– Act as seal to apical migration of gingival
epithelial cells.
• Reduced epithlial downgrowth.
• Greater soft tissue support because of lesser
marginal bone loss.

28. Conclusion
1. Immediate functional loading of implants in
single tooth replacements in the esthetic
zone maybe considered valuable and
predictable option .
2. Laser Lok implants for Immediate functional
loading in the esthetic zone provide better
results than the non laser lok implants.

29. Strengths
1. Title – explanatory and complete.
2. Study design- its a prospective and randomized
clinical trial. Outcome measure were clearly
defined . Well explained procedures.
3. Material and methods – Standardization of
radiographs done using customized silicone
stents and film holders
4. Caliberation of examiners – done
5. Extensive range of clinical and radiographic
parameters studied over long duration .

30. Weakness
1. Larger sample size .
2. Longer follow-up duration .