Effects of different loading protocols on the secondary stability and peri-implant bone density of the single implants in the posterior maxilla

Clinical efficacy of early and delayed loading implants: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Whether early loaded implants have similar clinical outcomes to delayed loaded implants is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to compare the outcomes of early and delayed loading dental implants.

MATERIAL AND METHODS

Comprehensive searches of the MEDLINE, EMBASE, and Ovid databases were enriched by hand searches. Only human randomized controlled trials (RCTs) that compared the clinical efficacy of early and delayed loading were included. The survival rates and marginal bone level (MBL) changes were pooled and analyzed by risk ratios (RRs) and weighted mean differences (WMDs), respectively. The subgroup analyses, which were based on the Mantel-Haenszel and inverse-variance methods, included the types of prosthesis, implant time, occlusion, number of missing teeth, operation methods, dental position, healing methods, and type of first restoration. A funnel plot was used for heterogeneity analysis.

RESULTS

Eighteen trials were included from the initial 601 articles. The dental implant survival rates for the early and delayed loading were similar (P>.05). Regarding the marginal bone level changes, the 2 loading protocols also reached a comparable clinical outcome (P>.05).

CONCLUSIONS

Early implant loading should achieve the same clinical efficacy as the delayed loading method.

A graftless maxillary sinus lifting approach with simultaneous dental implant placement: a prospective clinical study

PURPOSE

This study aimed to introduce a graftless sinus lifting approach with simultaneous dental implant placement in the alveolus of the posterior maxilla and compare this approach's outcomes in freshly extracted sockets versus healed sockets.

MATERIALS AND METHODS

A prospective study was conducted on 60 patients aged between 27 and 59 years old, requiring dental implants in the posterior maxilla, and diagnosed with reduced vertical bone height (30 with freshly extracted sockets (group A) and the remaining 30 with healed sockets (group B). Before the sinus lifting approach, a cone beam computed tomography (CBCT) was taken, followed by another CBCT at least one-year post-sinus lifting (range: 12-36 months). Biological and mechanical complications were assessed, and the primary implant stability was measured using the Implant Stability Quotient (ISQ). Parametric data were analyzed using an independent t-test for intergroup comparisons, with significance set at P < 0.05.

RESULTS

No significant differences were found among groups concerning gender, placement side, and follow-up. All dental implants demonstrated high survival rates with no observed biological or mechanical complications. Moreover, the primary implant stability was satisfactory, and there was no statistically significant difference (P = 0.38). In terms of new intrasinus bone formation, both groups exhibited satisfactory and successful outcomes, with increased new bone formation in group A. However, there was no statistically significant difference (P = 0.26). Regarding the vertical sinus floor elevation without new bone formation, group B showed (0.11 ± 0.64) mm of intrasinus implant height without bone formation, while group A showed an increment of bone formation above the intrasinus implant (0.22 ± 0.33) mm, with no statistically significant difference between both groups (P = 0.30).

CONCLUSION

Our approach proves to be predictable, low-cost, and efficient option for sinus lift procedures, demonstrating high survival rates with acceptable primary implant stability. Moreover, it yields satisfactory outcomes in terms of new intrasinus bone formation, both in freshly extracted and healed sockets. Consequently, our approach holds promise as a reliable procedure for sinus lifting with simultaneous dental implant placement.

Success rate of infrazygomatic crest mini-implants used for en-masse retraction of maxillary anterior teeth in first premolar extraction cases: A three-dimensional comparative prospective clinical trial between adolescents and young adults

BACKGROUND

The purpose of this study was to compare the success rate of infrazygomatic mini-implants between adolescents and young adults.

METHODS

A total of 60 subjects of different age groups ie, (group I [adolescents]: 12-18 years, mean age: 14.9 ± 2.9 years; group II [young adults]: 19-25 years, mean age = 21.9 ± 3.1 years) were assessed in the study. En-masse retraction of maxillary anterior teeth was carried out with extraction of upper first premolars with infrazygomatic crest (IZC) mini-implants as anchorage units. Clinical parameters such as success rate, soft tissue thickness, maximum insertion torque, maximum removal torque, pain response, soft tissue response, and cone-beam computed tomography parameters such as embedded angulation, penetration depth, thickness of bone on buccal and palatal aspect of mini-implant, and peri-implant bone density were evaluated.

RESULTS

The success rate of IZC mini-implants in adolescents was found to be 96.6% and 98.3% in young adults respectively. There was no significant difference in success rate between the two groups. Intergroup comparison showed a significant difference (P < 0.05) in terms of maximum insertion torque, maximum removal torque, soft tissue thickness, cortical bone thickness, and peri-implant bone density values. Comparison between right and left side revealed a significant difference (P < 0.05) with regards to soft tissue response, soft tissue thickness, total bone thickness, cortical bone thickness, and peri-implant bone density.

CONCLUSIONS

There was no significant difference in the success rate of IZC mini-implants between adolescents and young adults. Thus, the use of IZC mini-implants can be recommended in adolescents for successful orthodontic treatment.

Success rate of immediately loaded implants in the posterior zone

Dental implants are considered an ideal treatment for a missing single tooth. Immediate loading of implants can hasten the procedure, providing comfort to the patients. Recently, immediate loading of implants has gained much importance as it helps hasten the procedure and provides more comfort to patients. A previous systematic review published 5 years ago compared the success rates between immediate and conventional loading. There are several factors that influence the success rate of implants that were not discussed in detail in the previous review. Hence, the present systematic review is done to report differences in the outcomes from single implant restorations of missing teeth in the posterior region in patients who were subjected to immediate loading and conventional loading. A follow up for 1 year was done. Electronic databases of Medline, Scopus, and Web of Science were searched for publications in the English Language during May 2021. The search results yielded 306 articles, out of which 225 were excluded based on title and abstract screening. Screening of the remaining 81 full text articles yielded 14 original research articles that satisfied the predefined inclusion criteria. Meta analysis was not possible due to the heterogeneity of the data. The overall success rate of the immediate loading of a single implant is 94.31%. Implants in the maxillary region had a higher survival rate than those in the mandibular region. The age range between 18 and 80 years showed good prognosis and outcomes in older individuals. Good oral hygiene was emphasized for all patients to prevent any secondary conditions or delays in healing.

Patient-Specific Facial Implants in Polyetheretherketone and Their Stability: A Preliminary Study

BACKGROUND

Polyetheretherketone (PEEK) is a synthetic material with many favorable characteristics; PEEK implants are increasingly used for a variety of applications ranging from cranioplasty to orthopedic surgery and facial implants.

METHODS

This study is a retrospective review of patients who underwent PEEK implant placement in our department over the last 5 years. Polyetheretherketone computer-aided design and manufacture facial implants were designed from high-resolution computed tomography (CT) scans of each patient. The implants placed were onlay implants used for facial rehabilitation purposes to correct malformative and posttraumatic malformations.

RESULTS

Twenty-eight consecutive patients (11 males and 17 females) underwent PEEK implant positioning between January 2015 and December 2020. Common indications were anterior plagiocephaly, hemifacial microsomia, and residual facial imbalance after orthognathic surgery. No complications of implant breakdown, exposure, infection, or displacement were noticed during the follow-up period. During routine controls on 3 patients, we requested a craniomaxillofacial CT scan for reasons unrelated to the implanted prostheses. The CT scans were all high resolution (<1-mm slices). The CT images indicated that bone was starting to form around the implant in all 3 patients as well as in the penetrating holes that were planned in the implants.

CONCLUSIONS

In our experience, computer-designed, patient-specific PEEK onlay implants are a valid option for the treatment of malformative and posttraumatic malformations. This is, to the best of our knowledge, the first clinical report on bone reaction to PEEK implantation in the maxillofacial field. Moreover, based on the signs of bone regrowth that we observed in CT controls we can presume that the design of this type of prosthesis can probably take advantage of some technical stratagems not yet codified and fully exploited. Despite our preliminary favorable results, further multicentric and comparative studies are necessary to evaluate outcomes and better understand the behavior of this promising material and thus optimize its use in craniomaxillofacial surgery.

Immediate implant placement with simultaneous bone augmentation versus delayed implant placement following alveolar ridge preservation: A clinical and radiographic study

OBJECTIVE

The present study aimed to evaluate the clinical and radiographic outcomes of immediate implant placement (IIP) with guided bone regeneration (GBR) as compared to delayed implant placement (DIP) following alveolar ridge preservation (ARP) and to identify the potential risk factors influencing these outcomes.

METHODOLOGY

A total of 56 patients (IIP = 28 vs. DIP = 28) with class I or II bony defects received 56 implants were included. GBR procedure using Bio-Oss® bone substitute mixed with advanced platelet-rich fibrin (A-PRF) and covered by Bio-Gide® membrane and additional A-PRF membrane was performed either simultaneously with the IIP or earlier at the time of ARP in DIP. Clinical and 3-D radiographic analyses of bone level, thickness, and density were performed at three-time intervals (T1, immediately; T2, 6-7 months; and T3, 1.5 to 2 years post-implantation), corresponding to the neck, coronal, middle, and apex of implants.

RESULTS

The survival rate was 100% in both groups. IIP showed significant favorable outcomes regarding distal marginal bone level (anterior maxilla, T1-T3) and neck and coronal horizontal facial bone thickness (HFBT) (posterior maxilla, T1; and anterior maxilla, T1-T3, respectively) compared to DIP. However, DIP showed significant facial bone density at the neck and coronal parts in the anterior maxilla (T1) and the coronal part in the posterior maxilla (T3). The facial marginal bone level change was positively correlated with HFBT change (P = 0.007), which is negatively correlated with the secondary implant stability (P = 0.019). The implant region (anterior or posterior maxilla) was the only factor affecting on Implant stability quotient value (ISQ) and change in HFBT (P ˂ 0.05).

CONCLUSION

Overall, the IIP combined with GBR in the post-extraction sites with pre-implant class I or II bony defects had some favorable outcomes compared to DIP after ARP. However, the clinical outcomes, ISQ value, and changes in bone level, thickness, and density from T1-T3 were comparable.

Clinical assessment of different implant-supported esthetic crown systems fabricated with semi-digital workflow: Two-year prospective study

OBJECTIVE

To assess the clinical outcome of three esthetic implant-supported crown systems fabricated with semi-digital workflow and their influence on the clinical outcome of dental implants.

MATERIAL AND METHODS

A total of 30 participants had received dental implants restoring missing maxillary first/second premolars. After 6 weeks, customized zirconia abutments were early loaded. Two months later, the definitive crowns were fabricated using semi-digital workflow and cemented. According to the crown material, 3 groups were randomly allocated; group (Z): ultrahigh-translucent monolithic zirconia, group (C): resin-matrix ceramic and group (P): polyetherketoneketone veneered with light-cured composite resin. Clinical outcomes including the survival and success rates were evaluated at baseline, 6, 12, 18, and 24 months.

RESULTS

The survival rate for all studied groups was 100%, while their success rate was 100% for group (Z) and 90% for group (C) and group (P). Based on the functional implant prosthodontic score, a statistically significant difference was detected between group (Z) and group (P) (p < 0.001) as well as between group (C) and group (P) (p = 0.01).

CONCLUSIONS

The zirconia group had the most favorable clinical behavior, while the polyetherketoneketone had the least. All crown systems had comparable success rates with similar values of the peri-implant marginal bone loss.

CLINICAL SIGNIFICANCE

Using semi-digital workflow, ultrahigh-translucent monolithic zirconia, resin-matrix ceramic and polyetherketoneketone veneered with light-cured composite resin can be considered as favorable implant-supported crowns. The implant-supported crown system based on polyetherketoneketone veneered with light-cured composite resin is counted as a promising esthetic and restorative option.

Correlation between Primary, Secondary Stability, Bone Density, Percentage of Vital Bone Formation and Implant Size

BACKGROUND

This study aims to evaluate whether there is a correlation between implant stability, bone density, vital bone formation and implant diameter and length.

METHODS

Ninety patients were enrolled in this study. They underwent a socket preservation procedure with allograft or PRF and after 4 months, a total of 90 implants were placed. CBCT scans were assigned prior to implant placement in order to assess the bone density. During the surgical re-entry, a bone biopsy was harvested with a trephine drill. Immediately after implant insertion, the primary stability was measured. The secondary stability was measured 4 months after implant placement.

RESULTS

Primary stability showed a significant positive linear correlation with bone density (r = 0.471, p < 0.001) as well as with percentage of new bone formation (r = 0.567, p < 0.001). An average significant association of secondary stability with bone density (rs = 0.498, p < 0.001) and percentage of newly formed bone (r = 0.477, p < 0.001) was revealed. The mean values of primary stability in all three implant sizes, regarding the diameter of the implants, were similar (narrow 67.75; standard 66.78; wide 71.21) with no significant difference (p = 0.262). The same tendency was observed for secondary stability (narrow 73.83; standard 75.25; wide 74.93), with no significant difference (p = 0.277).

CONCLUSIONS

The study revealed a high correlation between primary and secondary implant stability, and bone density, as well as with the percentage of vital bone formation. Implant length and diameter revealed no linear correlation with the implant stability.

Factors Affecting Implant Stability Quotients at Immediately and Conventionally Loaded Implants in the Posterior Maxilla: A Split-Mouth Randomized Controlled Trial

PURPOSE

To assess primary and secondary stability of variable-thread tapered implants in the posterior maxilla and analyze the impact of various factors on implant stability quotients (ISQs).

MATERIALS AND METHODS

Twenty-six subjects received 3-4 adjacent implants in the maxillary premolar-molar sextants to replace bilateral tooth loss. The implants on one side were immediately loaded with a provisional fixed prosthesis regardless of their primary stability. The contralateral control implants were conventionally loaded. Bone quality was subjectively recorded and primary stability was assessed by means of insertion torque values (ITVs) and ISQs in 4 directions. Secondary stability was measured by ISQ at definitive prosthesis delivery (3-3.5 months postoperatively), and 12 months after definitive loading. The impact of measurement direction, loading protocol, time, site-related (bone quality, implant position, crestal buccal bone thickness, apical cortical anchorage), and implant-related (implant dimensions, abutment height) variables on ISQs was assessed.

RESULTS

For logistic reasons, ISQs were obtained for only 18 patients with 60 test and 60 control implants. Most of the implants (82%) at baseline had their lowest ISQ on the buccal aspect. There were no significant differences between ISQs measured in the buccal and palatal directions, or between ISQs in the mesial and distal directions. The mean of buccal and palatal ISQs was significantly lower than the mean of the 2 interproximal measurements at all evaluation periods. ISQs were not significantly different between the 2 loading groups at any time point. All implants showed a time-dependent increase in ISQs. Baseline ISQ correlated weakly with bone quality and ITV. None of the variables had a significant impact on baseline ISQs, except for implants in second molar sites which showed poorer primary stability than first premolars.

CONCLUSION

Measurement direction and time are the most significant parameters affecting ISQs of variable-thread tapered implants in the posterior maxilla.

The Bone Buttress Theory: The Effect of the Mechanical Loading of Bone on the Osseointegration of Dental Implants

Simple Summary

The bone, as a vertebrate support tissue, is capable of adapting its structure and function to the mechanical demands resulting from the loads that are produced during the performance of its activity. This regulatory action also occurs during the healing processes of a fracture. The purpose of this study was to determine to what extent a dynamic load was capable of modulating the bone healing response around a titanium implant. The study was carried out on experimental rabbits, to which dental implants were placed in the tibiae and there were two test groups, one in which they did not undergo exercise during healing period and another that ran daily during this process on a treadmill. The trail results showed an improvement in the osseointegration process of the implant in the group in which it was subjected to load. The importance of these results is that it opens the door to a better understanding of the mechanisms that can modulate bone healing, especially around dental implants, supporting implant loading protocols that are based on efficiency.

Abstract

Objectives: To determine the effect of mechanical loading of bone on the stability and histomorphometric variables of the osseointegration of dental implants using an experimental test in an animal model. Materials and Methods: A total of 4 human implants were placed in both tibiae of 10 New Zealand rabbits (n = 40). A 6-week osseointegration was considered, and the rabbits were randomly assigned to two groups: Group A (Test group) included 5 rabbits that ran on a treadmill for 20 min daily during the osseointegration period; Group B (Controls) included the other 5 that were housed conventionally. The monitored variables were related to the primary and secondary stability of the dental implants (implant stability quotient—ISQ), vertical bone growth, bone to implant contact (BIC), area of regenerated bone and the percentage of immature matrix. Results: The results of the study show a greater vertical bone growth (Group A 1.26 ± 0.48 mm, Group B 0.32 ± 0.47 mm, p < 0.001), higher ISQ values (Group A 11.25 ± 6.10 ISQ, 15.73%; Group B 5.80 ± 5.97 ISQ, 7.99%, p = 0.006) and a higher BIC (Group A 19.37%, Group B 23.60%, p = 0.0058) for implants in the test group, with statistically significant differences. A higher percentage of immature bone matrix was observed for implants in the control group (20.68 ± 9.53) than those in the test group (15.38 ± 8.84) (p = 0.108). A larger area of regenerated bone was also observed for the test implants (Group A 280.50 ± 125.40 mm², Group B 228.00 ± 141.40 mm²), but it was not statistically significant (p = 0.121). Conclusions: The mechanical loading of bone improves the stability and the histomorphometric variables of the osseointegration of dental implants.

Anatomy of the mandibular canal and surrounding structures. Part II: Cancellous pattern of the mandible

PURPOSE

It is necessary to correlate cancellous bone patterns with cone beam computed tomography (CBCT) images, but this has not been done to date. The goal of this study was to establish how the superior wall of the mandibular canal (MC) on CBCT images correlates with the cancellous bone around the MC on gross anatomical findings.

METHODS

Twenty sides from 10 dry mandibles derived from six females and four males were used for this study. In order to observe the MC distally, the specimen was prepared by the method used in our previous study. The cancellous bone around the MC was observed and classified into three types: type I (trabecular pattern), type II (osteoporotic pattern), and type III (dense/irregular pattern). The mandibles were examined with CBCT and the superior wall of the MC on CBCT was scored as visible or non-visible. Finally, the scores (visible or non-visible) were compared to the type by gross observation.

RESULTS

For gross observation, a total of 80 areas were available for this study. The data were added to those from our previous study. As a result, 155 areas on 40 sides were analyzed. In dentulous sections, types I, II, and III were found in 55.8%, 20.9%, and 23.3%, respectively. In edentulous sections, the corresponding percentages were 25.0%, 41.1%, and 33.9%, respectively. The dentulous sections was more likely than edentulous to have a type I mandible in both sexes. More females than males had type II (osteoporotic) mandibles. When the superior wall of the MC was non-visible on CBCT, the cancellous bone was type II in 80%.

CONCLUSIONS

We believe the results can easily be applied to preoperative diagnosis with not only radiological but also anatomical evidence. This classification now necessitates clinical trials for further evidence.

Changes of Radiographic Trabecular Bone Density and Peri-Implant Marginal Bone Vertical Dimensions Around Non-Submerged Dental Implants with a Laser-Microtextured Collar after 5 Years of Functional Loading

Objectives:

The progressive peri-implant bone remodeling caused by dynamic cycles of microdamage may change peri-implant bone characteristics and volume after the functional loading.

This prospective study was designed to evaluate the radiographic trabecular bone density and peri-implant vertical dimensional changes around the non submerged dental implant with a laser-microtextured collar (NSLI)s after 5 years of functional loading.

Methods:

Digital periapical radiographs of 58 NSLIs supported fixed single crowns and fixed partial dentures in 26 patients (14 men, mean age of 52 ± 3.8 years) were used for comparative evaluation between the implant placement [Baseline (BSL)], the definitive Crowns Delivery (CD) and the 5 years post-functional loading examination (T5). Regions of interest (ROI) were taken into consideration for the measurement of mean gray levels, standard deviation, and variation coefficient. The texture parameters, such as contrast, correlation, angular second moment and entropy, were investigated by using the software ImageJ (v.1.50i), by means of the Gray-level Co-occurrence Matrix (GLCM) Texture Tool plugin. Vertical Peri-implant Marginal Bone Level (VPMBL) was assessed at the mesial and the distal sides of each implant by subtracting the measure at BSL from the measure at T5 by means of dedicate software (VixWin Platinum Imaging Software). Mixed regression models were adopted to analyze data. The possible effects of some variables, such as the use of provisional denture, location, crown/implant ratio, type of prosthetic design (single or splinted), on radiographic dimensional vertical changes, gray levels and texture analysis variables were also evaluated.

Results:

From BSL to T5, mesial and distal VPMBL showed a statistically significant gain of 0.9 ±0.5, and 0.10 mm ±0.6, respectively (P<0.05). From CD to T5, mean gray levels increased from 94.4±26.8) to 111.8±27.1 (P<0.05), while the coefficient of variation decreased from 0.08±0,03 to 0.05±0.04) (P<0.05). Variables showed no statistically significant correlation with texture parameters (P > 0.05).

Conclusion:

NSLIs showed an increase in radiographic vertical peri-implant marginal bone levels and bone density up to 5 years of loading.

Radiographic changes of trabecular bone density after loading of implant-supported complete dentures: A 3-year prospective study

BACKGROUND

Bone tissues may undergo remodeling under functional mechanical stimuli.

PURPOSE

This prospective study on implant-supported fixed complete dentures (IFCDs) evaluated the radiographic trabecular bone changes in density by means of gray levels and texture analysis variables after up to 3-year loading.

MATERIALS AND METHODS

The sample consisted of digital periapical radiographs of 63 distal implants of hybrid IFCDs installed in 30 patients (22 women, mean age of 62 ± 7.8 years). Digital periapical radiographs were taken after prosthesis installation, and 1 and 3 years after IFCD loading. Longitudinal images of each implant were superimposed, and the same regions of interest were selected for measurement of gray levels statistics (mean gray levels, SD, and coefficient of variation [CV]) and texture parameters (correlation, contrast, entropy, and angular second moment). Data were analyzed by mixed regression models.

RESULTS

Mean gray levels increased for 1 year (P < .05), for 3 years (P < .01) and for maximum bite force (P < .01). The interaction between bruxism and time in 1 year was significant (P < .01) for a decrease in CV. No significant effect of texture analysis variables was found (P > .05).

CONCLUSIONS

The results suggest an increase of radiographic bone density as measured by an increase in mean gray levels and a decrease in CV in IFCD distal implants up to 3 years of loading.

Using Resonance Frequency Analysis to Compare Delayed and Immediate Progressive Loading for Implants Placed in the Posterior Maxilla: A Pilot Study

Objective:

Implants placed in the posterior region of the maxilla have a high incidence of implant failure due to poor bone quality, especially when immediate implant loading is needed. Immediate Progressive Loading (IPL) can enhance bone quality and may offer an alternative solution when Immediate Implant loading is needed.

Methods:

Six patients (one male and five females; 34-62 years old) were included in this study. Twelve implants were inserted in the posterior region of the maxilla. Resonance Frequency Analysis (RFA) was performed at the time of implant placement and after 1, 2, 3 and 6 months. ISQ (Implant Stability Quotient) values were compared between the Delayed Loading (DL) group after 2 months and the Progressive Loading (PL) group and between different time points for each group.

Results:

At implant placement, the mean ISQ values for PL and DL implants were 63 and 57, respectively. One month after implant placement, the mean ISQ value for PL implants was 73.

Two months after implant placement, the mean ISQ value for PL implants was 75. Three months after implant placement, the mean ISQ values for PL and DL implants were 76 and 69, respectively. Six months after implant placement, the mean ISQ values for PL and DL implants were 79 and 76, respectively.

Conclusion:

Despite its limitations, this pilot study indicated that compared to DL, PL can enhance bone density and implant stability, resulting in greater early functionality and fewer surgery sessions.

Clinical Assessment of Dental Implant Stability During Follow-Up: What Is Actually Measured, and Perspectives

The optimization of loading protocols following dental implant insertion requires setting up patient-specific protocols, customized according to the actual implant osseointegration, measured through quantitative, objective methods. Various devices for the assessment of implant stability as an indirect measure of implant osseointegration have been developed. They are analyzed here, introducing the respective physical models, outlining major advantages and critical aspects, and reporting their clinical performance. A careful discussion of underlying hypotheses is finally reported, as is a suggestion for further development of instrumentation and signal analysis.

Scanning Electron Microscope (SEM) Evaluation of the Interface between a Nanostructured Calcium-Incorporated Dental Implant Surface and the Human Bone

Purpose. The aim of this scanning electron microscope (SEM) study was to investigate the interface between the bone and a novel nanostructured calcium-incorporated dental implant surface in humans. Methods. A dental implant (Anyridge^®, Megagen Implant Co., Gyeongbuk, South Korea) with a nanostructured calcium-incorporated surface (Xpeed^®, Megagen Implant Co., Gyeongbuk, South Korea), which had been placed a month earlier in a fully healed site of the posterior maxilla (#14) of a 48-year-old female patient, and which had been subjected to immediate functional loading, was removed after a traumatic injury. Despite the violent trauma that caused mobilization of the fixture, its surface appeared to be covered by a firmly attached, intact tissue; therefore, it was subjected to SEM examination. The implant surface of an unused nanostructured calcium-incorporated implant was also observed under SEM, as control. Results. The surface of the unused implant showed a highly-structured texture, carved by irregular, multi-scale hollows reminiscent of a fractal structure. It appeared perfectly clean and devoid of any contamination. The human specimen showed trabecular bone firmly anchored to the implant surface, bridging the screw threads and filling the spaces among them. Conclusions. Within the limits of this human histological report, the sample analyzed showed that the nanostructured calcium-incorporated surface was covered by new bone, one month after placement in the posterior maxilla, under an immediate functional loading protocol.