Digitally assisted immediate implant placement in posterior mandibular long-span prostheses: a prospective evaluation of loading protocols and clinical outcomes.
AIM To compare the clinical outcomes of digitally assisted immediate implant placement in the posterior mandible using immediate (Type A) and delayed (Type C) loading protocols. METHODS Eighty-two patients requiring five-unit fixed partial dentures supported by three implants were consecutively enrolled. All cases were planned using a fully digital workflow integrating CBCT, intraoral scanning, and static computer-guided surgery. Only implants achieving adequate primary stability (insertion torque ≥25 Ncm and/or ISQ ≥60) were included. Patients were assigned to either immediate or delayed loading protocols. Implant survival, marginal bone loss (MBL), plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were evaluated over variable follow-up periods according to the timing of patient enrollment and treatment completion. RESULTS A total of 246 implants were placed, yielding an overall survival rate of 97.5% with no significant differences between loading protocols. Mean MBL was 0.7 mm and remained comparable between groups. Peri-implant parameters, including PI, BOP, and PD, were stable throughout follow-up. Regression analysis identified restorative angles >30° as the only significant predictor of increased MBL. CONCLUSION Digitally guided immediate implant placement in the posterior mandible demonstrated high survival rates and favorable peri-implant outcomes with both Type A and Type C loading protocols. CLINICAL SIGNIFICANCE Type A loading may provide a predictable and time-efficient alternative to conventional delayed loading without compromising clinical outcomes.