The Effect of Ecobone on the Osseointegration and Stability of the maxillary Immediately placed Implants

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Emara, Mohamed Eldesouky Elkalyouby This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8492555/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Peri-implant gaps that occur between the edges of the implant and the walls of the socket pose a major difficulty for immediate implantation currently. This research sought to address these deficiencies with ecobone graft, which does not require a membrane, and examine its impact on the stability and osseointegration of implants inserted in the maxilla. The study involved 24 cases, divided into the study group (with ecobone additive putty) and the control group, examining the effect on jumping distances. The results suggested that the material was significant, as evidenced by implant stability measurements, probing pocket depth, and the modified sulcus bleeding index Physical sciences/Engineering Health sciences/Health care Physical sciences/Materials science Health sciences/Medical research implant stability quotient implant osseointegration Alloplastic graft material jumping gaps Ecobone graft Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Introduction Treatment time is reduced when the implants are placed right away. It prevents the need for an open flap surgery and the potential necessity for hard and soft tissue grafting. 1 . In order to achieve easier and faster surgical treatment times, various loading and placement techniques have been developed. 2 . in 1976, Schulte and Heimke were the first to report the immediate implantation of a dental implant in an extraction socket . 1 Experiments have been conducted to determine the optimal outcomes for osseointegration. 3 In an early investigation, Akimoto et al 4 conducted an initial study to examine the effects of dogs' jumping space size. After flap elevation, osteotomies were over prepared coronally but of the right size apically to have sufficient implant stability, creating simulated extraction sockets. All jumping distances showed clinically full bone fill after 12 weeks of site healing. Variable bone grafts, including autogenous, alloplastic, and xenograft materials, have been utilized to address this issue, yet there hasn't been a clear consensus on whether one type is better than the others. The autogenous bone graft necessitates an additional surgical procedure, while both the alloplastic and xenograft bone grafts are more expensive for the patient and require membrane coverage to prevent epithelialization. Consequently, a novel alloplastic graft substance (ecobone additive putty) that is simpler to use and requires no membrane covering will be beneficial 5 . While they may not perfectly replicate the natural architecture of bone, alloplastic graft substitutes are man-made materials containing certain chemical components found in natural bone, like calcium and phosphate, and are recognized for promoting bone regeneration. In contrast to allogeneic and xenogenic transplants, alloplastic bone grafts offer the benefits of uniform product quality and eliminate the risk of infectious diseases. The main advantages of alloplastic bone substitutes are their biological stability and ability to maintain volume, allowing for cell infiltration and remodeling. Synthetic bone replacements exhibit varying osteoconductive abilities based on their compositions, production methods, mechanical properties, crystal formations, pore dimensions, porosity levels, and absorption rates 6 . Beta tricalcium phosphate graft material is a putty-like additive that contains silicate material, originating from alloplastic sources, designed for the repair of bone defects from surgical procedures or traumatic injuries. It enhances bone regeneration and supports the development of new bone tissue in weight-bearing clinical settings. It can be combined with bone marrow, blood, and other recognized grafts in clinical use. It lacks human or animal tissue, so there is no danger of disease transmission. It possesses osteoinductive and osteoconductive properties, functioning as a framework for cells to facilitate new bone development, while also having a composition akin to the naturally occurring mineral present in bone. The silicate additive enhances protein retention for grafting and imparts bioactive properties. Biodegradable in nature, β-TCP possesses a chemical structure that supports a continuous regeneration cycle of healthy bone during healing, gradually being absorbed and encouraging bone growth 7 . Materials and methods Aim of the study This study aimed to assess the effect of Ecobone additive putty on the peri implant spaces of the maxillary immediately placed implants. Ethical considerations Ethical approval for this study was obtained from the Research Ethics Committee (REC) at the Faculty of Oral and Dental Medicine, Delta University for Science and Technology. All methods were performed in accordance with the relevant guidelines and regulations. Teeth extraction was for indicated reasons, regardless of the purpose of this study, e.g. teeth are non-restorable, badly destructed, with grade 3 mobility or remaining roots. An informed consent was taken voluntarily from each patient before performing the procedure. Study setting: The research took place in the outpatient surgical dental clinic within the Department of Oral and Maxillofacial Surgery at the Faculty of Oral and Dental Medicine, Delta University for Science and Technology. The research comprised 24 distinct teeth derived from CBCT scans of 24 individuals. The teeth captured in the scans must possess unbroken buccal plates. The implants were placed in the sockets right after extraction, with some receiving alloplastic grafts to fill the jumping gap (study group) and others without (control group), to achieve clear results related to the study. Voluntary informed consent was obtained from each case to carry out the procedure Patients: Inclusion criteria: Eligible patients were aged 25 to 65 years, with no preference for gender. Participants needed to be medically fit, non-smokers, and willingly pursuing implant placement. Exclusion criteria: Patients excluded were those under 25 years or over 65 years. Individuals who smoke and those with complex medical conditions such as diabetes mellitus, uncontrolled hypertension, or any other ailments that hinder the healing of bone and soft tissue, including periodontitis, were excluded. Surgical procedure: Teeth extraction was initially performed using an atraumatic method, prioritizing the preservation of both the socket bony walls and the soft tissues. After preparing the sockets with surgical drills under abundant saline irrigation, the implants were placed. The gap around the implant was filled with (ecobone) a membrane-free alloplastic graft material (beta tricalcium phosphate with silicate), which was applied only to 12 patients in group I [study group]. In the other 12 patients in group II [control group], implant placement was performed without grafting. Evaluation: i) Clinical measures of implant stability: a) The implant stability quotient (ISQ) is a scale from 1 to 100 used to evaluate the stability of an implant. Four measurements were collected. ISQ values were recorded right after implant placement (Tx), following the prosthesis loading (T0), six months post-surgery (T1), and one year after the surgery (T2) 8 . b) Modified sulcus bleeding index: clinical signs and symptoms indicating inflammation of the peri-implant mucosa were assessed one month after the implant placement (T1) and again two months post-implant placement (T2) at four locations surrounding each implant (labial, palatal, mesial, and distal). The MSBI score varies from 0 to 3, with a score of 0 indicating no bleeding when a periodontal probe is moved along the gingival margin next to the implant; score 1 signifies occasional bleeding spots; score 2 represents bleeding that creates a continuous red line at the margins; and score 3 indicates severe or excessive bleeding 9 . c) Probing pocket depth (PPD): a calibrated probe was utilized to assess the distance from the pocket's base to the gingival margin, recorded three months post-implant placement (T1) and six months after surgery (T2). The probe was inserted alongside the implant base. 10 ii) Radiographic assessment of implant osseointegration: The evaluation of the stability and osseointegration of the implant was made using cone beam computed tomography (CBCT) and panoramic x-ray as follows: a) Every patient was subjected to a preoperative CBCT and also a year later for noticing the osseointegration of the surrounding bone. b) Patients’ recall was at 3 months, six months, and 1 year to judge the success of implant. 11 Results Statistical evaluation and interpretation: Data were analyzed using SPSS software, version 26 (SPSS Inc., PASW statistics for Windows version 26). Chicago, Illinois: SPSS Inc. Quantitative data were represented using numbers and percentages. The Shapiro-Wilk test was applied to assess normality, and the mean ± standard deviation was utilized to present quantitative data that followed a normal distribution. The importance of the results was evaluated at the 0.05 level. The Chi-Square test was used as needed to compare qualitative data across different groups. The Stewart Maxwell Marginal homogeneity test was utilized to compare qualitative data prior to and following treatment. For data that is not normally distributed, the student t test was used to compare two independent groups. Two matched readings of distributed data were analyzed using the paired t-test. The paired t-test was applied to compare two sets of paired readings with distributed data. The joint effect of two separate factors on the continuous dependent outcome was analyzed using the two-way ANOVA test, with R2 calculated. Implant stability quotients (ISQ) ISQ Study group n=12 Control group n=12 Test of significance Tx 80±4.76 78.33±5.36 t=0.804 p=0.430 T0 83.58±4.68 82±4.86 t=0.813 p=0.425 T1 86.67±2.46 84.17±4.68 t=1.64 p=0.116 T2 87.92±2.57 87.25±3.14 t=0.569 p=0.575 t:Student t test, data expressed as mean±SD Table ():comparison of ISQ change within each of studied groups ISQ Test of significance Tx T0 T1 T2 Study group 80±4.76 83.58±4.68 86.67±2.46 a 87.92±2.57 a F=25.94 P= 0.001* Control group 78.33±5.36 82±4.86 a 84.17±4.68 a 87.25±3.14 F= 11.89 P= 0.001* F: Repeated Measures ANOVA test , *statistically significant Similar superscripted letters in same row denote non-significant difference between different follow up periods , data expressed as mean±SD. Table (): TWO Way ANOVA test was used to assess effect of change in time and group on ISQ among studied cases. Source Type III Sum of Squares Df Mean Square F p value. Partial Eta Squared Corrected Model 1017.406 a 7 145.344 8.214 .001* .395 Intercept 673182.510 1 673182.510 38045.530 .001* .998 group 61.760 1 61.760 3.490 .065 .038 time 945.531 3 315.177 17.813 .001* .378 group * time 10.115 3 3.372 .191 .903 .006 Error 1557.083 88 17.694 Total 675757.000 96 Corrected Total 2574.490 95 a. R Squared = .395 (Adjusted R Squared = .347) Modified sulcus bleeding index (MSBI) Table (): comparison of bleeding index between studied groups Bleeding index Study group n=12 Control group n=12 Test of significance T1 Score 0 Score 1 Score 2 2(16.7) 10(83.3) 0(0.0) 0(0.0) 7(58.3) 5(41.7) ꭓ 2 =7.52 P=0.023* T2 Score 0 Score 1 8(66.7) 4(33.3) 8(66.7) 4(33.3) ꭓ 2FET =0.0 P=1.0 Mꭓ 2 :Chi-Square test , FET: Fisher exact test data expressed as N(%) Table (): comparison of bleeding index between T1 &T2 within studied groups Bleeding index T1 T2 Test of significance Study group Score 0 Score 1 2(16.7) 10(83.3) 8(66.7) 4(33.3) SM= 2.15 P=0 .014* Control group Score 0 Score 1 Score 2 0(0.0) 7(58.3) 5(41.7) 8(66.7) 4(33.3) 0 SM= 3.13 P= 0.002* SM: Stuart Maxwell test, *statistically significant data expressed as N(%) Table (): TWO Way ANOVA test was used to assess effect of change in time and group on bleeding index among studied cases. Source Type III Sum of Squares Df Mean Square F p value Partial Eta Squared Corrected Model 9.563 a 3 3.188 14.143 .001* .491 Intercept 25.521 1 25.521 113.235 .001* .720 group 1.021 1 1.021 4.529 .039* .093 time 7.521 1 7.521 33.370 .001* .431 group * time 1.021 1 1.021 4.529 .039* .093 Error 9.917 44 .225 Total 45.000 48 Corrected Total 19.479 47 a. R Squared = .491 (Adjusted R Squared = .456) Probing pocket depth (PPD): Table (): comparison of probing depth between studied groups Probing depth Study group Control group Test of significance T1 3.50±0.52 3.42±0.51 t=0.394 p=0.698 T2 3.0±0.0 3.17±0.39 t=1.48 p=0.152 t:Student t test, data expressed as mean±SD Table (): comparison of probing depth between T1 versus T2 Probing depth T1 T2 Test of significance Study group 3.50±0.52 3.0±0.0 t= 3.32 p= 0.007* Control group 3.42±0.51 3.17±0.39 t= 1.92 p= 0.082 t:Paired t test , data expressed as mean±SD Table (): TWO Way ANOVA test was used to assess effect of change in time and group on probing depth among studied cases. Source Type III Sum of Squares df Mean Square F p value Partial Eta Squared Corrected Model .750 a 3 .250 1.535 .219 .095 Intercept 494.083 1 494.083 3033.442 .001* .986 group .083 1 .083 .512 .478 .011 time .333 1 .333 2.047 .160 .044 group * time .333 1 .333 2.047 .160 .044 Error 7.167 44 .163 Total 502.000 48 Corrected Total 7.917 47 a. R Squared = .095 (Adjusted R Squared = .033) Discussion It is essential to recognize that the grafting technique enhances the initial stability of immediate implants, demonstrated by the ISQ falling below 65. This aligns with the results of the research conducted by Doddarayapete N. Umashankar regarding the efficacy of calcium phosphosilicate as a grafting material in bone defects, which assessed bone density. The test group exhibited greater average bone density in the immediate, fourth, and sixth months post-surgery, respectively, compared to 102.9 before the operation with a p-value of <0.001 (T) .which is statistically significant,Grafting the jumping distances with bone substitutes was advantageous due to the effect of increasing the primary stability of implants, ALthough Santos et al, (S) estimated recent animal and human studies of bone substitutes used for jumping spaces defects in post-extraction implants, the effect of the graft procedure on implant primary stability has not been further studied. They came to the conclusion that while implant placement in newly extracted sockets is a dependable way to shorten treatment times, a biomaterial must be used to improve osseointegration outcomes and increase bone-implant contact.. Our results show that the mean and standard deviation of Time 2's Modified Sulcus Bleeding Index (MSBI) were considerably lower than those of Time 1. This indicated that our score was 1 (visible isolated bleeding spots). The tissue around the implant shows greater inflammation with increased plaque and sulcular bleeding scores. Müller, F., et al. observed comparable results with titanium-zirconium and small-diameter titanium grade IV implants in toothless mandibles. After 60 months, there were no noticeable differences in mPI or mSBI between the TiZr and Ti Grade IV patients (p = 0.23 and 0.77, respectively) 12 13 Due to the possibility of false positive or negative results, pocket probing depth is a variable that does not always indicate treatment outcome. However, a crucial component of periodontal examination is the estimation of clinical probing depth. 14 , and is very important because deeper pockets and increased inflammation are signs of worsening periodontitis. Additional attachment loss is more likely to occur in areas with PPD ≥ 6 mm. Because many healthy sites cover changes in sites with disease progression, using patient means to calculate can be deceptive. 15 . In order to reduce the effect of masking, PPDs can be grouped according to different thresholds. Our results indicate that PPD was notably reduced in Time (2) compared to Time (1). This aligns with additional studies by Echeverría, J.J., A. Echeverría, and R.G.J.P. (Adherence to supportive periodontal treatment) that showed that maintaining periodontal care results in reduced plaque and bleeding on probing, potentially halting or slowing disease progression. Ultimately, patient adherence was seen as a disease-modifying element that beneficially influences tooth longevity according to various retrospective studies 16 17 . These results agree with those of Abrahamsson, I., et al ., (Early bone formation adjacent to rough and turned endosseous implant surfaces) 18 . However, all pointed out that an increase in PPD is not necessarily equivalent to attachment loss. Conclusion According to the aforementioned research findings, the ecobone had a positive impact on the stability and osseointegration of implants that were placed right away when compared to the control group. This was demonstrated by the increase in implant stability quotients (ISQ) and the decrease in the Modified Sulcus Bleeding Index (MSBI) and Probing Pocket Depth (PPD) Declarations Disclosure : there was no conflict of interest in this work. Data Availability The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. Funding Declaration : there was no Funding . Author Contribution All Authors reviewed the manuscriptDr Mostafa Adel Taha as a corresponding author was the researcher who commit all the study clinical and theoretical work , wrote the main manuscript text and prepared the figures .prof Seham Abdelfattah. Emara , supervised the whole research clinically and theoretically , supervised the final research edition and participate in the figures and the manuscript modifications.Dr Mohamed Eldesouky Elkalyouby supervised the clinical work and the follow up of the cases , modified the figures and manuscript. Data Availability The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. References HuynhBa G, Oates TW, Williams MA. Immediate loading vs. early conventional loading of immediately placed implants in partially edentulous patients from the patients’ perspective: a systematic review. Clin Oral Impl Res 2018;(Suppl 16):255–269. Schulte W, Heimke G. The Tubinger immediate implant. Quintessence 1976;( 27):17–23. Botticelli D, Berglundh T, Buser D, Lindhe J. The jumping distance revisited: An experimental study in the dog. Clin Oral Implants Res 2003;(14): 35-42 . Akimoto K, Becker W, Persson R, Baker DA, Rohrer MD, O'Neal RB. Evaluation of titanium implants placed into simulated extraction sockets: A study in dogs. Int Journal Oral Maxillofac Implants 1999 ;(14):351–360. Chatzopoulos, G.S. and L.F.J.J.o.C.M. Wolff, Survival rates and factors affecting the outcome following immediate and delayed implant placement: a retrospective study. 2022. 11(15): p. 4598. Kuo, P.-J., et al., A novel application of dynamic guided navigation system in immediate implant placement. 2022. 17(1): p. 354-360. Shunfeng Wang 1, Xiaohong, Wang 2, Florian G Draenert 3, Olga Albert 1, Heinz C Schröder 1, Volker Mailänder 4, Gergo Mitov 5, Werner E G Müller.Bioactive and biodegradable silica biomaterial for bone regeneration. Bone 2014 Oct:67:292-304 . Huang H., Wismeijer D., Shao X., Wu G. Mathematical evaluation of the influence of multiple factors on implant stability quotient values in clinical practice: a retrospective study. Therapeut Clin Risk Manag. Dove Press Journal 2016; (12):1525–1532. Benamghar L, Penaud J, Kaminsky P, Abt F, Martin J, Comparison of gingival index and sulcus bleeding index as indicators of periodontal status. Bull World Health Organ 1982; (1): 147–151. Abrahamsson, I., Berglundh, T., Linder, E., Lang, N.P. & Lindhe, J. Early bone formation adjacent to rough and turned endosseous implant surfaces. An experimental study in the dog. Clinical Oral Implants Research 2004; (15): 381– 392. Abrahamsson, I., Linder, E. & Lang, N.P. Implant stability in relation to osseointegration: an experimental study in the Labrador dog. Clinical Oral Implants Research 2009 ;( 20): 313– 318. Müller, F., et al., Small-diameter titanium grade IV and titanium-zirconium implants in edentulous mandibles: five-year results from a double-blind, randomized controlled trial. 2015. 15: p. 1-10. Rahnama-Hezavah, M., et al., How Can Imbalance in Oral Microbiota and Immune Response Lead to Dental Implant Problems? 2023. 24(24): p. 17620 Echeverría, J.J., A. Echeverría, and R.G.J.P. Caffesse, Adherence to supportive periodontal treatment. 2019. 79(1): p. 200-209. Loos, B.G. and I.J.J.o.C.P. Needleman, Endpoints of active periodontal therapy. 2020. 47: p. 61-71. Ribeiro, F.V., et al., Minimal invasiveness in nonsurgical periodontal therapy. 2023. 91(1): p. 7-19. Loos, B.G. and I.J.J.o.C.P. Needleman, Endpoints of active periodontal therapy. 2020. 47: p. 61-71. Abrahamsson, I., et al., Early bone formation adjacent to rough and turned endosseous implant surfaces: an experimental study in the dog. 2004. 15(4): p. 381-392. Santos, P.L., et al., Bone substitutes for periimplant defects of postextraction implants. 2013. 2013(1): p. 307136. Doddarayapete N Umashankar, Kranthi S Kumar, R Mahesh Kumar, Narasimhamurthy Srinath, Chaithra Patil. Efficacy of calcium phosphosilicate as graft material in bony defects. January 2018International Journal of Oral Care & Research 6(1):17-23 Additional Declarations No competing interests reported. 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2","display":"","copyAsset":false,"role":"figure","size":95918,"visible":true,"origin":"","legend":"\u003cp\u003eImplants in place before ecobone application\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8492555/v1/2869bd9fe1625529ffe32ded.jpg"},{"id":101204509,"identity":"767dd7f1-9164-4870-852f-423b0570dd2b","added_by":"auto","created_at":"2026-01-27 09:43:25","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":109275,"visible":true,"origin":"","legend":"\u003cp\u003eShowing implant in place after ecobone additive putty graft addittion\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8492555/v1/5388eb9e55557a2d7ec8bbaf.jpg"},{"id":101203812,"identity":"7d7d7138-865b-4d84-98c0-1680ba2e65e3","added_by":"auto","created_at":"2026-01-27 09:40:43","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":37142,"visible":true,"origin":"","legend":"\u003cp\u003eShowing the beta tricalcium phosphate with silicate and its consistency(ecobone)\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8492555/v1/007d2c3e5434e0b3bc0c91b2.jpg"},{"id":101018915,"identity":"29b70c20-7414-4aee-b7a4-bd4a32449855","added_by":"auto","created_at":"2026-01-24 00:34:39","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":15002,"visible":true,"origin":"","legend":"\u003cp\u003eShowing (osstell) for measuring the implant stability.\u003c/p\u003e","description":"","filename":"5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8492555/v1/ae13675dd5683e5c497239f5.jpg"},{"id":101018926,"identity":"acab908f-db66-4573-a7a6-175475c47214","added_by":"auto","created_at":"2026-01-24 00:34:40","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":96202,"visible":true,"origin":"","legend":"\u003cp\u003eShowing clinical crowns a three months post operation\u003c/p\u003e","description":"","filename":"6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8492555/v1/7101aa6609b1d602fec30871.jpg"},{"id":101204114,"identity":"0c657933-43ab-4ab9-9503-705ca1a396d3","added_by":"auto","created_at":"2026-01-27 09:41:39","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":83691,"visible":true,"origin":"","legend":"\u003cp\u003eShowing clinical restorations a six months post operation\u003c/p\u003e","description":"","filename":"7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8492555/v1/2997c8ef857504e854d06cc3.jpg"},{"id":101018922,"identity":"e0fb4e75-b42d-40b5-a4ab-00edfa2c32e5","added_by":"auto","created_at":"2026-01-24 00:34:40","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":58994,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eShowing the CBCT of the immediately placed Implant a year after operation\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"8.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8492555/v1/9acee9b69b76205abae5571e.jpg"},{"id":101018923,"identity":"97b630cc-fc49-4289-90ff-0c0bfdfdb6dc","added_by":"auto","created_at":"2026-01-24 00:34:40","extension":"jpg","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":96369,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eshowing abutments and final restorations six months post operation\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"9.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8492555/v1/fc6c4b019271a1db0dbbe2c2.jpg"},{"id":101204307,"identity":"2beba2a2-2a2b-4688-8698-8ad004810a92","added_by":"auto","created_at":"2026-01-27 09:42:38","extension":"jpg","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":72975,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"un1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8492555/v1/58dcc7611b7111d28591604e.jpg"},{"id":101204668,"identity":"8d65425d-6d0d-4d3b-b6c5-ea181333b2a1","added_by":"auto","created_at":"2026-01-27 09:43:39","extension":"jpg","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":67616,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"un2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8492555/v1/50312f383b763eff118e4c91.jpg"},{"id":101204763,"identity":"d88c71fa-7031-4438-b9c6-4a085995fb44","added_by":"auto","created_at":"2026-01-27 09:43:51","extension":"jpg","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":59437,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"un3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8492555/v1/0062ec3f6fd921c3cb36c9a0.jpg"},{"id":101018929,"identity":"ba2799a7-d4df-41ee-9dc4-abe27a4d1cbe","added_by":"auto","created_at":"2026-01-24 00:34:40","extension":"jpg","order_by":13,"title":"Figure 13","display":"","copyAsset":false,"role":"figure","size":51567,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"un4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8492555/v1/0b7b295c86c8f0e5292f8633.jpg"},{"id":105566660,"identity":"cdb8a0fd-09a9-430b-83a2-9269a352db26","added_by":"auto","created_at":"2026-03-27 12:56:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2246171,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8492555/v1/0a34a03b-ad35-4af8-9d8e-114818c7951a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effect of Ecobone on the Osseointegration and Stability of the maxillary Immediately placed Implants","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTreatment time is reduced when the implants are placed right away. It prevents the need for an open flap surgery and the potential necessity for hard and soft tissue\u0026nbsp;grafting.\u003csup\u003e1\u003c/sup\u003e . In order to achieve easier and faster surgical treatment times, various loading and placement techniques have been developed.\u003csup\u003e2\u003c/sup\u003e\u003cstrong\u003e.\u003c/strong\u003e in 1976, Schulte and Heimke were the first to report the immediate implantation of a dental implant in an extraction socket .\u003cstrong\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e Experiments have been conducted to determine the optimal outcomes for osseointegration.\u003csup\u003e3\u003c/sup\u003e In an early investigation, Akimoto \u003cem\u003eet al\u003c/em\u003e \u003csup\u003e4\u003c/sup\u003e conducted an initial study to examine the effects of dogs\u0026apos; jumping space size. After flap elevation, osteotomies were over prepared coronally but of the right size apically to have sufficient implant stability, creating simulated extraction sockets. All jumping distances showed clinically full bone fill after 12 weeks of site healing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVariable bone grafts, including autogenous, alloplastic, and xenograft materials, have been utilized to address this issue, yet there hasn\u0026apos;t been a clear consensus on whether one type is better than the others. The autogenous bone graft necessitates an additional surgical procedure, while both the alloplastic and xenograft bone grafts are more expensive for the patient and require membrane coverage to prevent epithelialization. Consequently, a novel alloplastic graft substance (ecobone additive putty) that is simpler to use and requires no membrane covering will be beneficial\u003csup\u003e5\u003c/sup\u003e. While they may not perfectly replicate the natural architecture of bone, alloplastic graft substitutes are man-made materials containing certain chemical components found in natural bone, like calcium and phosphate, and are recognized for promoting bone regeneration. In contrast to allogeneic and xenogenic transplants, alloplastic bone grafts offer the benefits of uniform product quality and eliminate the risk of infectious diseases. The main advantages of alloplastic bone substitutes are their biological stability and ability to maintain volume, allowing for cell infiltration and remodeling. Synthetic bone replacements exhibit varying osteoconductive abilities based on their compositions, production methods, mechanical properties, crystal formations, pore dimensions, porosity levels, and absorption rates\u003csup\u003e6\u003c/sup\u003e. Beta tricalcium phosphate graft material is a putty-like additive that contains silicate material, originating from alloplastic sources, designed for the repair of bone defects from surgical procedures or traumatic injuries. It enhances bone regeneration and supports the development of new bone tissue in weight-bearing clinical settings. It can be combined with bone marrow, blood, and other recognized grafts in clinical use. It lacks human or animal tissue, so there is no danger of disease transmission. It possesses osteoinductive and osteoconductive properties, functioning as a framework for cells to facilitate new bone development, while also having a composition akin to the naturally occurring mineral present in bone. The silicate additive enhances protein retention for grafting and imparts bioactive properties. Biodegradable in nature, \u0026beta;-TCP possesses a chemical structure that supports a continuous regeneration cycle of healthy bone during healing, gradually being absorbed and encouraging bone growth\u003csup\u003e7\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eAim of the study\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study aimed to assess the effect of Ecobone additive putty on the peri implant spaces of the maxillary immediately placed implants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eEthical considerations\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Ethical approval for this study was obtained from the Research Ethics Committee (REC) at the Faculty of Oral and Dental Medicine, Delta University for Science and Technology.\u0026nbsp; \u0026nbsp;All methods were performed in accordance with the relevant guidelines and \u0026nbsp;regulations.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Teeth extraction was for indicated \u0026nbsp;reasons, regardless of the purpose of this study, e.g. teeth are non-restorable, badly destructed, with grade 3 mobility or remaining roots. An informed consent was taken voluntarily from each patient before performing the procedure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eStudy setting:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research took place in the outpatient surgical dental clinic within the Department of Oral and Maxillofacial Surgery at the Faculty of Oral and Dental Medicine, Delta University for Science and Technology. The research comprised 24 distinct teeth derived from CBCT scans of 24 individuals. The teeth captured in the scans must possess unbroken buccal plates. The implants were placed in the sockets right after extraction, with some receiving alloplastic grafts to fill the jumping gap (study group) and others without (control group), to achieve clear results related to the study. Voluntary informed consent was obtained from each case to carry out the procedure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003ePatients:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInclusion criteria: Eligible patients were aged 25 to 65 years, with no preference for gender. Participants needed to be medically fit, non-smokers, and willingly pursuing implant placement.\u003c/p\u003e\n\u003cp\u003eExclusion criteria: Patients excluded were those under 25 years or over 65 years. Individuals who smoke and those with complex medical conditions such as diabetes mellitus, uncontrolled hypertension, or any other ailments that hinder the healing of bone and soft tissue, including periodontitis, were excluded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eSurgical procedure:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTeeth extraction was initially performed using an atraumatic method, prioritizing the preservation of both the socket bony walls and the soft tissues. After preparing the sockets with surgical drills under abundant saline irrigation, the implants were placed. The gap around the implant was filled with (ecobone) a membrane-free alloplastic graft material (beta tricalcium phosphate with silicate), which was applied only to 12 patients in group I [study group]. In the other 12 patients in group II [control group], implant placement was performed without grafting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eEvaluation:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003ei) Clinical measures of implant stability:\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ea) The implant stability quotient (ISQ) is a scale from 1 to 100 used to evaluate the stability of an implant. Four measurements were collected. ISQ values were recorded right after implant placement (Tx), following the prosthesis loading (T0), six months post-surgery (T1), and one year after the surgery (T2)\u003csup\u003e8\u003c/sup\u003e\u003cstrong\u003e.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eb) Modified sulcus bleeding index: clinical signs and symptoms indicating inflammation of the peri-implant mucosa were assessed one month after the implant placement (T1) and again two months post-implant placement (T2) at four locations surrounding each implant (labial, palatal, mesial, and distal). The MSBI score varies from 0 to 3, with a score of 0 indicating no bleeding when a periodontal probe is moved along the gingival margin next to the implant; score 1 signifies occasional bleeding spots; score 2 represents bleeding that creates a continuous red line at the margins; and score 3 indicates severe or excessive bleeding\u003csup\u003e9\u003c/sup\u003e\u003cstrong\u003e.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ec)\u0026nbsp;Probing pocket depth (PPD): a calibrated probe was utilized to assess the distance from the pocket\u0026apos;s base to the gingival margin, recorded three months post-implant placement (T1) and six months after surgery (T2). The probe was inserted alongside the implant base.\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eii) Radiographic assessment of implant osseointegration:\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe evaluation of the stability and osseointegration of the implant\u0026nbsp;was made using cone beam computed tomography (CBCT) and panoramic x-ray as follows:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ea)\u0026nbsp; \u0026nbsp;Every patient was subjected to\u0026nbsp;a\u0026nbsp;preoperative CBCT and also a year later for noticing the\u0026nbsp;osseointegration of the surrounding bone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eb)\u0026nbsp;\u0026nbsp;Patients\u0026rsquo; recall was at 3 months, six months, and 1 year to judge the success of\u0026nbsp;implant.\u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eStatistical evaluation and interpretation: Data were analyzed using SPSS software, version 26 (SPSS Inc., PASW statistics for Windows version 26). Chicago, Illinois: SPSS Inc. Quantitative data were represented using numbers and percentages. The Shapiro-Wilk test was applied to assess normality, and the mean \u0026plusmn; standard deviation was utilized to present quantitative data that followed a normal distribution. The importance of the results was evaluated at the 0.05 level. The Chi-Square test was used as needed to compare qualitative data across different groups. The Stewart Maxwell Marginal homogeneity test was utilized to compare qualitative data prior to and following treatment. For data that is not normally distributed, the student t test was used to compare two independent groups. Two matched readings of distributed data were analyzed using the paired t-test. The paired t-test was applied to compare two sets of paired \u0026nbsp;readings with distributed data. The joint effect of two separate factors on the continuous dependent outcome was analyzed using the two-way ANOVA test, with R2 calculated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eImplant stability quotients (ISQ)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eISQ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest of significance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTx\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e80\u0026plusmn;4.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e78.33\u0026plusmn;5.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003et=0.804\u003c/p\u003e\n \u003cp\u003ep=0.430\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e83.58\u0026plusmn;4.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e82\u0026plusmn;4.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003et=0.813\u003c/p\u003e\n \u003cp\u003ep=0.425\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e86.67\u0026plusmn;2.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e84.17\u0026plusmn;4.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003et=1.64\u003c/p\u003e\n \u003cp\u003ep=0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e87.92\u0026plusmn;2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e87.25\u0026plusmn;3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\"\u003e\n \u003cp\u003et=0.569\u003c/p\u003e\n \u003cp\u003ep=0.575\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003et:Student t test, data expressed as mean\u0026plusmn;SD\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable ():comparison of ISQ change within each of studied groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 420px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eISQ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest of significance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eTx\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eT0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e80\u0026plusmn;4.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e83.58\u0026plusmn;4.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e86.67\u0026plusmn;2.46\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e87.92\u0026plusmn;2.57\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eF=25.94\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eP= 0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e78.33\u0026plusmn;5.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e82\u0026plusmn;4.86\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e84.17\u0026plusmn;4.68\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\n \u003cp\u003e87.25\u0026plusmn;3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eF= 11.89\u003c/p\u003e\n \u003cp\u003eP= 0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eF: Repeated Measures \u0026nbsp;ANOVA test , *statistically significant\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSimilar superscripted letters in same row denote non-significant difference between different follow up periods\u003c/p\u003e\n\u003cp\u003e, data expressed as mean\u0026plusmn;SD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (): TWO Way ANOVA test was used to assess effect of change in time and group on ISQ among studied cases.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType III Sum of Squares\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDf\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Square\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartial Eta Squared\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eCorrected Model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e1017.406\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e145.344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e8.214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e.395\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e673182.510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e673182.510\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e38045.530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e.998\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003egroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e61.760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e61.760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e3.490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e.038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003etime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e945.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e315.177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e17.813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e.378\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003egroup * time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e10.115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e3.372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e.191\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e.903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eError\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e1557.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e17.694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e675757.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eCorrected Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e2574.490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 100px;\"\u003e\n \u003cp\u003ea. R Squared = .395 (Adjusted R Squared = .347)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eModified sulcus bleeding index (MSBI)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (): comparison of bleeding index between studied groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBleeding index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en=12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest of significance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eScore 0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eScore 1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eScore 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2(16.7)\u003c/p\u003e\n \u003cp\u003e10(83.3)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e7(58.3)\u003c/p\u003e\n \u003cp\u003e5(41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eꭓ\u003csup\u003e2\u003c/sup\u003e=7.52\u003c/p\u003e\n \u003cp\u003eP=0.023*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eScore 0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eScore 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8(66.7)\u003c/p\u003e\n \u003cp\u003e4(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8(66.7)\u003c/p\u003e\n \u003cp\u003e4(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eꭓ\u003csup\u003e2FET\u003c/sup\u003e=0.0\u003c/p\u003e\n \u003cp\u003eP=1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMꭓ\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e:Chi-Square\u003csup\u003e\u0026nbsp;\u003c/sup\u003etest , FET: Fisher exact test\u0026nbsp;\u003c/p\u003e\n\u003cp\u003edata expressed as N(%)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (): comparison of bleeding index between T1 \u0026amp;T2 within \u0026nbsp; studied groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBleeding index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest of significance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eScore 0\u003c/p\u003e\n \u003cp\u003eScore 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2(16.7)\u003c/p\u003e\n \u003cp\u003e10(83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8(66.7)\u003c/p\u003e\n \u003cp\u003e4(33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003eSM= 2.15\u003c/p\u003e\n \u003cp\u003eP=0 .014*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eScore 0\u003c/p\u003e\n \u003cp\u003eScore 1\u003c/p\u003e\n \u003cp\u003eScore 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e7(58.3)\u003c/p\u003e\n \u003cp\u003e5(41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e8(66.7)\u003c/p\u003e\n \u003cp\u003e4(33.3)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 149px;\"\u003e\n \u003cp\u003eSM= 3.13\u003c/p\u003e\n \u003cp\u003eP= 0.002*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSM: Stuart Maxwell test, *statistically significant\u0026nbsp;\u003c/p\u003e\n\u003cp\u003edata expressed as N(%)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (): TWO Way ANOVA test was used to assess effect of change in time and group on bleeding index among studied cases.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType III Sum of Squares\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDf\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Square\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartial Eta Squared\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eCorrected Model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e9.563\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e3.188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e14.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e.491\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e25.521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e25.521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e113.235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e.720\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003egroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e1.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e4.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e.039*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003etime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e7.521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e7.521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e33.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e.431\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003egroup * time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e1.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e1.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e4.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e.039*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eError\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e9.917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e45.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eCorrected Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e19.479\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 100px;\"\u003e\n \u003cp\u003ea. R Squared = .491 (Adjusted R Squared = .456)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eProbing pocket depth (PPD):\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (): comparison of probing depth between studied groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProbing depth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest of significance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e3.50\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e3.42\u0026plusmn;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003et=0.394\u003c/p\u003e\n \u003cp\u003ep=0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e3.0\u0026plusmn;0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e3.17\u0026plusmn;0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003et=1.48\u003c/p\u003e\n \u003cp\u003ep=0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003et:Student t test, data expressed as mean\u0026plusmn;SD\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (): comparison of probing depth between T1 versus T2\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProbing depth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest of significance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e3.50\u0026plusmn;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e3.0\u0026plusmn;0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003et= 3.32\u003c/p\u003e\n \u003cp\u003ep= 0.007*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 157px;\"\u003e\n \u003cp\u003e3.42\u0026plusmn;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e3.17\u0026plusmn;0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 160px;\"\u003e\n \u003cp\u003et= 1.92\u003c/p\u003e\n \u003cp\u003ep= 0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003et:Paired t test , data expressed as mean\u0026plusmn;SD\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (): TWO Way ANOVA test was used to assess effect of change in time and group on probing depth among studied cases.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType III Sum of Squares\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003edf\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Square\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartial Eta Squared\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eCorrected Model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e.750\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1.535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e.219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e494.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e494.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e3033.442\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e.986\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003egroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e.478\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003etime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e2.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003egroup * time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e2.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eError\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e7.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e502.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eCorrected Total\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e7.917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" style=\"width: 100px;\"\u003e\n \u003cp\u003ea. R Squared = .095 (Adjusted R Squared = .033)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eIt is essential to recognize that the grafting technique enhances the initial stability of immediate implants, demonstrated by the ISQ falling below 65. This aligns with the results of the research conducted by Doddarayapete N. Umashankar regarding the efficacy of calcium phosphosilicate as a grafting material in bone defects, which assessed bone density. The test group exhibited greater average bone density in the immediate, fourth, and sixth months post-surgery, respectively, compared to 102.9 before the operation with a p-value of \u0026lt;0.001\u003cstrong\u003e\u003csup\u003e\u0026nbsp;(T)\u003c/sup\u003e\u003c/strong\u003e .which is statistically significant,Grafting the jumping distances with bone substitutes was advantageous due to the effect of increasing the primary stability of implants, ALthough \u003cstrong\u003e\u003cem\u003eSantos et al,\u003c/em\u003e\u003c/strong\u003e \u003cstrong\u003e\u003csup\u003e(S)\u003c/sup\u003e\u003c/strong\u003e estimated recent animal and human studies of bone substitutes used for jumping spaces defects in post-extraction implants, the effect of the graft procedure on implant primary stability has not been further studied. They came to the conclusion that while implant placement in newly extracted sockets is a dependable way to shorten treatment times, a biomaterial must be used to improve osseointegration outcomes and increase bone-implant contact..\u003c/p\u003e\n\u003cp\u003eOur results show that the mean and standard deviation of Time 2\u0026apos;s Modified Sulcus Bleeding Index (MSBI) were considerably lower than those of Time 1. This indicated that our score was 1 (visible isolated bleeding spots). The tissue around the implant shows greater inflammation with increased plaque and sulcular bleeding scores. M\u0026uuml;ller, F., et al. observed comparable results with titanium-zirconium and small-diameter titanium grade IV implants in toothless mandibles. After 60 months, there were no noticeable differences in mPI or mSBI between the TiZr and Ti Grade IV patients (p = 0.23 and 0.77, respectively)\u003csup\u003e12\u003c/sup\u003e \u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eDue to the possibility of false positive or negative results, pocket probing depth is a variable that does not always indicate treatment outcome. However, a crucial component of periodontal examination is the estimation of clinical probing depth. \u003csup\u003e14\u003c/sup\u003e, and is very important because deeper pockets and increased inflammation are signs of worsening periodontitis. Additional attachment loss is more likely to occur in areas with PPD \u0026ge; 6 mm. Because many healthy sites cover changes in sites with disease progression, using patient means to calculate can be deceptive. \u003csup\u003e15\u003c/sup\u003e. In order to reduce the effect of masking, PPDs can be grouped according to different thresholds.\u003c/p\u003e\n\u003cp\u003eOur results indicate that PPD was notably reduced in Time (2) compared to Time (1). This aligns with additional studies by Echeverr\u0026iacute;a, J.J., A. Echeverr\u0026iacute;a, and R.G.J.P. (Adherence to supportive periodontal treatment) that showed that maintaining periodontal care results in reduced plaque and bleeding on probing, potentially halting or slowing disease progression. Ultimately, patient adherence was seen as a disease-modifying element that beneficially influences tooth longevity according to various retrospective studies\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e16\u003c/sup\u003e\u003c/strong\u003e \u003csup\u003e17\u003c/sup\u003e. These results agree with those of\u003cstrong\u003e\u0026nbsp;Abrahamsson, I., et al\u003c/strong\u003e., (Early bone formation adjacent to rough and turned endosseous implant surfaces)\u003csup\u003e18\u003c/sup\u003e. However, all pointed out that an increase in PPD is not necessarily equivalent to attachment loss.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAccording to the aforementioned research findings, the ecobone had a positive impact on the stability and osseointegration of implants that were placed right away when compared to the control group. This was demonstrated by the increase in implant stability quotients (ISQ) and the decrease in the Modified Sulcus Bleeding Index (MSBI) and Probing Pocket Depth (PPD)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eDisclosure\u003c/span\u003e:\u003c/h2\u003e \u003cp\u003ethere was no conflict of interest in this work.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eData Availability\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eDeclaration\u003c/span\u003e: there was no Funding .\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll Authors reviewed the manuscriptDr Mostafa Adel Taha as a corresponding author was the researcher who commit all the study clinical and theoretical work , wrote the main manuscript text and prepared the figures .prof Seham Abdelfattah. Emara , supervised the whole research clinically and theoretically , supervised the final research edition and participate in the figures and the manuscript modifications.Dr Mohamed Eldesouky Elkalyouby supervised the clinical work and the follow up of the cases , modified the figures and manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHuynhBa G, Oates TW, Williams MA. Immediate loading vs. early conventional loading of immediately placed implants in partially edentulous patients from the patients\u0026rsquo; perspective: a systematic review. Clin Oral Impl Res 2018;(Suppl 16):255\u0026ndash;269.\u003c/li\u003e\n\u003cli\u003eSchulte W, Heimke G. The Tubinger immediate implant. Quintessence 1976;( 27):17\u0026ndash;23.\u003c/li\u003e\n\u003cli\u003eBotticelli D, Berglundh T, Buser D, Lindhe J. The jumping distance revisited: An experimental study in the dog. Clin Oral Implants Res 2003;(14): 35-42 .\u003c/li\u003e\n\u003cli\u003eAkimoto K, Becker W, Persson R, Baker DA, Rohrer MD, O\u0026apos;Neal RB. Evaluation of titanium implants placed into simulated extraction sockets: A study in dogs. Int Journal Oral Maxillofac Implants 1999 ;(14):351\u0026ndash;360.\u003c/li\u003e\n\u003cli\u003eChatzopoulos, G.S. and L.F.J.J.o.C.M. Wolff, Survival rates and factors affecting the outcome following immediate and delayed implant placement: a retrospective study. 2022. 11(15): p. 4598.\u003c/li\u003e\n\u003cli\u003eKuo, P.-J., et al., A novel application of dynamic guided navigation system in immediate implant placement. 2022. 17(1): p. 354-360.\u003c/li\u003e\n\u003cli\u003eShunfeng Wang 1, Xiaohong, Wang 2, Florian G Draenert 3, Olga Albert 1, Heinz C Schr\u0026ouml;der 1, Volker Mail\u0026auml;nder 4, Gergo Mitov 5, Werner E G M\u0026uuml;ller.Bioactive and biodegradable silica biomaterial for bone regeneration. Bone 2014 Oct:67:292-304 .\u003c/li\u003e\n\u003cli\u003eHuang H., Wismeijer D., Shao X., Wu G. Mathematical evaluation of the influence of multiple factors on implant stability quotient values in clinical practice: a retrospective study. Therapeut Clin Risk Manag. Dove Press Journal 2016; (12):1525\u0026ndash;1532.\u003c/li\u003e\n\u003cli\u003eBenamghar L, Penaud J, Kaminsky P, Abt F, Martin J, Comparison of gingival index and sulcus bleeding index as indicators of periodontal status. Bull World Health Organ 1982; (1): 147\u0026ndash;151. \u003c/li\u003e\n\u003cli\u003eAbrahamsson, I., Berglundh, T., Linder, E., Lang, N.P. \u0026amp; Lindhe, J. Early bone formation adjacent to rough and turned endosseous implant surfaces. An experimental study in the dog. Clinical Oral Implants Research 2004; (15): 381\u0026ndash; 392.\u003c/li\u003e\n\u003cli\u003eAbrahamsson, I., Linder, E. \u0026amp; Lang, N.P. Implant stability in relation to osseointegration: an experimental study in the Labrador dog. Clinical Oral Implants Research 2009 ;( 20): 313\u0026ndash; 318.\u003c/li\u003e\n\u003cli\u003eM\u0026uuml;ller, F., et al., Small-diameter titanium grade IV and titanium-zirconium implants in edentulous mandibles: five-year results from a double-blind, randomized controlled trial. 2015. 15: p. 1-10.\u003c/li\u003e\n\u003cli\u003eRahnama-Hezavah, M., et al., How Can Imbalance in Oral Microbiota and Immune Response Lead to Dental Implant Problems? 2023. 24(24): p. 17620\u003c/li\u003e\n\u003cli\u003eEcheverr\u0026iacute;a, J.J., A. Echeverr\u0026iacute;a, and R.G.J.P. Caffesse, Adherence to supportive periodontal treatment. 2019. 79(1): p. 200-209.\u003c/li\u003e\n\u003cli\u003eLoos, B.G. and I.J.J.o.C.P. Needleman, Endpoints of active periodontal therapy. 2020. 47: p. 61-71.\u003c/li\u003e\n\u003cli\u003eRibeiro, F.V., et al., Minimal invasiveness in nonsurgical periodontal therapy. 2023. 91(1): p. 7-19.\u003c/li\u003e\n\u003cli\u003eLoos, B.G. and I.J.J.o.C.P. Needleman, Endpoints of active periodontal therapy. 2020. 47: p. 61-71.\u003c/li\u003e\n\u003cli\u003eAbrahamsson, I., et al., Early bone formation adjacent to rough and turned endosseous implant surfaces: an experimental study in the dog. 2004. 15(4): p. 381-392. \u003c/li\u003e\n\u003cli\u003eSantos, P.L., et al., Bone substitutes for periimplant defects of postextraction implants. 2013. 2013(1): p. 307136.\u003c/li\u003e\n\u003cli\u003eDoddarayapete N Umashankar, Kranthi S Kumar, R Mahesh Kumar, Narasimhamurthy Srinath, Chaithra Patil. Efficacy of calcium phosphosilicate as graft material in bony defects. January 2018International Journal of Oral Care \u0026amp; Research 6(1):17-23\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"implant stability quotient, implant osseointegration, Alloplastic graft material, jumping gaps, Ecobone graft","lastPublishedDoi":"10.21203/rs.3.rs-8492555/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8492555/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePeri-implant gaps that occur between the edges of the implant and the walls of the socket pose a major difficulty for immediate implantation currently. This research sought to address these deficiencies with ecobone graft, which does not require a membrane, and examine its impact on the stability and osseointegration of implants inserted in the maxilla. The study involved 24 cases, divided into the study group (with ecobone additive putty) and the control group, examining the effect on jumping distances. The results suggested that the material was significant, as evidenced by implant stability measurements, probing pocket depth, and the modified sulcus bleeding index\u003c/p\u003e","manuscriptTitle":"The Effect of Ecobone on the Osseointegration and Stability of the maxillary Immediately placed Implants","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-24 00:34:34","doi":"10.21203/rs.3.rs-8492555/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4c48241f-7109-4c58-9146-50f25fa6f008","owner":[],"postedDate":"January 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":61557596,"name":"Physical sciences/Engineering"},{"id":61557597,"name":"Health sciences/Health care"},{"id":61557598,"name":"Physical sciences/Materials science"},{"id":61557599,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-03-25T23:53:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-24 00:34:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8492555","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8492555","identity":"rs-8492555","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}