978 D3000 new imprint Word template Vol 13, No 1 (2025) ISSN 2167-8677 (online) DOI 10.5195/d3000.2025.978 http://dentistry3000.pitt.edu Stability Assessmernt with Immediate Loading Using Blx Slactive Den- tal Implant Ahmed Abdulkareem Mahmood College of Den*stry, Tikrit University, Iraq Abstract Objec2ve: To assess the primary and secondary stability of dental implants with immediate loading protocol. Material and Methods: Thirty paLents between the ages of 18 and 45 years who received forty dental implants were study. These cases involved bone level x mod- ified sand blast large grit acid etch Blx Sla acLve implant. ATer surgery, the primary stabil- ity was examined while secondary stability was evaluated 3 months later. The SPSS program was used to evaluate and analyze the results employing the paired T test and independent T test at p <0.05. Results: Thirty pa'ents, 20 females and 10 males, par'cipated in this study and had a mean age of 32 years. In comparison to the primary stability baseline value, the mean implant stability quoLent values for secondary stability aTer three months showed a staLsLcally significant improvement. Sex and jaws did not differ significantly in terms of sta- bility. Conclusion: When compared to the iniLal primary stability baseline values, the study found that secondary implant stability measured values for the type of dental implant studied increased significantly. Open Access Cita%on: Mahmood AA. (2025) Stability Assessment with Immediate Loading Using Blx Slac%ve Dental Implant. Den%stry 3000. 1:a001 doi:10.5195/d3000.2025.978 Received: July 3, 2025 Accepted: July 4, 2025 Published: August 21, 2025 Copyright: ©2025 Mahmood AA. This is an open access ar%cle licensed under a Crea%ve Commons AUribu%on Work 4.0 United States License. Email: ahmedabdulkareem@tu.edu.iq Introduc)on Restoring missing teeth with the placement of endosseous dental implants is a popular therapeutic option for achieving good cos- metic and functional outcomes [1]. Brånemark >irst suggested that the implants be submerged and unloaded for three to six months [2]. Due to this lengthy duration, a different load- ing protocol had to be implemented to re- duce time. Immediate loading is when the prosthesis is placed within three days of the implant being placed. A satisfactory level of osseointegration is anticipated following the surgical implantation of dental implants. The initial protocol called for a two-step surgical process for Branemark implants to become osseo integrated [3]. Lack of mobility is regarded as a clinical con- dition of implant stability [4]. It is typically separated into two categories: primary stability, or mechanical engage- ment, and secondary stability, or biological osseo integration. The >irmness that arises from the mechanical interaction between the implant and the bone is known as primary stability. Secondary stability is the outcome of new bone cells growing around the bio- compatible implant leading to osseo integra- tion [5]. More stability has been the aim of many implant designs [6]. The Straumann BLX is one such implant design. This kind of dental implant is superior because it is en- tirely tapered and has strong stability, espe- cially in low quality of bone. It is constructed using Roxolid® and the surface treatment of dental implants made with a large grit acid- etched surface with BLX modi>ied sandblast (BLX SLActive) [7]. The titanium surface is given a macro-roughness by employing a big grit sandblasting process with corundum particles to create the SLA surface of the implant. After that, there is a vigorous acid- etching bath at a higher temperature for a few minutes. The topography that results provides the perfect framework for cell at- tachment [8]. Similar to SLA, the chemically modi>ied sand- blasted, large grit, and acid etched surface (SLActive) was applied, but with the addition of washing under protective N2 conditions and packing in isotonic solution (NaCl). This produced almost 60% more bone formation than SLA implants by improving surface chemistry and signi>icantly enhancing hy- drophilic qualities [9]. By preventing infec- tion and encouraging a quicker recovery, an- tibiotics administered after surgery lessen discomfort and accelerate healing. The most notable effects on pain relief and healing were shown by augmentin and azithromy- cin, which also successfully controlled infec- tion and improved recovery [10]. Stability Assessmernt with Immediate Loading Using Blx SlacLve Dental Implant Vol 13, No 1 (2025) DOI 10.5195/d3000.2025.978 http://dentistry3000.pitt.edu 2 Materials and Methods 30 Iraqi patients between the ages of 18 and 45 years —ten men and twenty women— who met the study's eligibility requirements were enrolled. To evaluate the primary and secondary stability, these patients were con- tained inside a group of 40 dental implants (BLX SLActive implant). Clinical and radio- graphic examinations of the hard and soft tis- sues were conducted at the dental implant surgery site using orthopantomography (OPG). Eligibility criteria Good overall health free of local or systemic disorders such >ibrous dysplasia, hyperpara- thyroidism, heavy smoking, etc. that could impair bone healing ability. Patients gender of both male and female, aged > 18 years. Ac- cording to the SAC classi>ication, straight for- ward cases involving partially edentulous maxilla or mandible (short span – one or two teeth loss) were handled as delayed implant implantation protocols (at least 6 months af- ter tooth extraction). Exclusion criteria Patients were excluded if any of the follow- ing conditions were present: psychological disease, impractical expectations, or current pregnancy, Uncontrolled systemic disorders such as uncontrolled diabe- tes, head and neck radiation or chemother- apy within the last >ive years, or patients re- ceiving bisphosphate treatment can all im- pair natural healing or make it more dif>i- cult for a patient to recover from surgery. Local problems in the implant zone include acute or chronic infections, poor oral hy- giene, and local pathological diseases. Cases that were advanced and complex based on the SAC classi>ication, as well as any clinical or historical evidence of parafunctional be- haviors (such as clenching or bruxism), were excluded. Surgical procedure Using the in>iltration technique, local anes- thetic of the intended surgical >ield was achieved using lidocaine 2%, starting with one tooth prior to and after the implantation site. Depending on the relevant criteria and the surgeon's evaluation, the implantation procedure was performed using either the >lapped or >lapless technique. The drilling procedure was carried out in compliance with the manufacturer's recommendations. As seen in Figure 1, the implant bed was pre- pared using spiral drills, serial drilling, and copious amounts of normal saline irrigation in accordance with the BLX implant system's recommendations until the desired diameter was reached. A surgical micro-motor hand piece with a torque of 35 Ncm and a speed of 15 rpm was used to introduce the implants, as shown in Figure 2. Figure 1. The BLX drill during osteotomy. Figure 2. Installation of the BLX SLActive im- plant in the prepared site. A torque ratchet up to 50 Ncm was used to manually seat dental implants into their ulti- mate position, and the Penguin RFA tool with smart peg type 38 was used to measure the ISQ immediately as a primary stability and secondary stability were also evaluated and recorded. As shown in Figure 3, the average of the measurements taken in the buccopalatal and mesiodistal directions was recorded. Figure 3. Measurement of the ISQ using Pen- guin RFA and smart peg type 38. For the >lapping technique, the incision was closed using interrupted 3/0 braided black silk sutures. Co-amoxiclav tab 625 mg were to be taken three times daily for >ive days, along with a 250 mg tablet of metronidazole three times daily. When necessary, 50 mg tabs of diclofenac potassium are given as an effective pain reliever. Within 3 days after implant insertion, the patients underwent the immediate loading protocol with screw- retained restorations in non-functional oc- clusion shown in Figure 4. Figure 4. Screw retained restoration. Follow up and measurement of secondary stability Three months after loading, the screw-re- tained restoration was disconnected to as- sess secondary stability in a manner identi- cal to that of the primary stability, and a screwdriver and a ratchet with a torque of 35 Ncm tightened the screw-retained restora- tion and re inserted into its functional posi- tion. A Te>lon piece was inserted into the screw hole, and the composite >illing mate- rial (light cured) with functional occlusion was packed into it. Statistical analysis IBM SPSS (Statistical Package for Social Sci- ences) version 26 was used to evaluate data. These data were tested using the paired T test and independent T test. P<0.05 indicates signi>icance. Results 24 dental implants were placed in the man- dible and 16 implants in the maxillary bone. The average ISQ values for the implants' sec- ondary stability three months after loading were noticeably higher than those for the primary stability (72.63 versus 81.75). After three months, there is a statistically signi>icant difference between primary and secondary stability (<0.05). On the other hand, the study showed no sig- ni>icant differences between primary stabil- ity and secondary stability among male and female patients as noticed in Table 1. There were no signi>icant differences in pri- mary and secondary stability in relation to implant site in maxillary and mandibular arches (Table 2). Stability Assessmernt with Immediate Loading Using Blx SlacLve Dental Implant Vol 13, No 1 (2025) DOI 10.5195/d3000.2025.978 http://dentistry3000.pitt.edu 3 Discussion In this study, gender and implant had no effect on stabilit y. But, considering additional elements includi ng surgical technique, implant design, and b one quality, individual evaluations are still e ssential. The means of secondary stability ISQ values in the current research were substantially h igher than the baseline values for primary st ability. Additionally, the means of primary and seco ndary stability for the maxillary and mandib ular arches, as well as between male and fe male patients, did not differ signi>icantly [11 ]. The study's >inding that primary and second ary stability differ signi>icantly is consistent with previous studies showing that these tw o types of stability are separate. While secondary stability is necessary for lo ng- term success, primary stability is critical for the >irst post-implantation phase [12]. Gender had no effect on implant stability, which is in line with work by others [13]. However, work indicated that the ISQ value for female patients was higher than that of male patients [14], and this disagreed with men that had a greater implant stability value than women [15]. Contrary to some existing literature, the study's findings showed that implant stability is unaffected by the implant site in both arches. In general, greater primary stability is linked to the mandible's denser bone than the maxilla. The results of this study, however, could be explained by elements like implant design, surgical method, or bone quality in a particular patient. A study by Lang et al. highlighted the impact of bone density and quality by reporting variations in implant stability across the maxilla and mandible [16]. However Zhang et al. did a meta- analysis which revealed that the implant sit e had no significant impact on implant stabil ity. This suggests that other parameters, incl uding implant length and implantation time, are more important in determining stability than location [17]. Similarly, a study conducted by Abd El-Hady et al. assessed how implant materials affected the stability according to the study's findings, the material composition of the implant had a greater impact on its stability than the precise location within the maxilla or mandible [18]. Conclusions After three months, there was a statistically signi>icant increase in implant stability in comparison to primary stability. References 1. Manzano-Moreno, F., Herrera-Briones, F., Bassam, T., et al. Factors Affecting Dental Im- plant Stability Measured Using the Ostell Mentor Device. Implant Dent 2015; 24:565-577. 2. Sommer, M., Zimmermann, J., Grize, L. et al. Marginal bone loss one year after implantation: a systematic review of different loading protocols. Int J Oral Maxillofac Surg 2020; 49:121-134. 3. Misch CE, Wang HL, Misch CM, Sharawy M, Lemons J, Judy KW. Rationale for the application of immediate load in implant dentistry: Part I. Implant Dent. 2004; 13: 207-17. 4. Andreotti, A., Goiato, M., Nobrega, A., et al. Rela- tionship Between Implant Stability Measurements Obtained by Two Different Devices: A Systematic Review. J Periodontol 2020; 88:281-288. 5. Kittur, N., Oak, R., Dekate, D.,et al. Dental implant stability and its measurements to improve osse- ointegration at the bone-implant interface: A re- view. Materials Today: Proceedings. 2021; 43:1064-1070. 6. Cooper, L., De Kok, I., Reside, G., et al. Immediate Fixed Restoration of the Edentulous Maxilla After Implant Placement. J Oral Maxillofac Surg 2005; 63:97-110. 7. Kordusky, Benjamin Andrew. Accuracy of BLX and BLT guided implants in the edentulous max- illa: an in vivo study. Graduate Theses, Disserta- tions, and Problem Reports. 2020; 7544. 8. Preshaw, P. Summary of: Implant surface char- acteristics and their effect on osseointegration. Br Dent J 2015; 218:292-293. 9. Nicolau P, Guerra F, Reis R, et al. 10-year out- comes with immediate and early loaded implants with a chemically modibied SLA surface. Quintes- sence Int J 2019; 50: 114-124. 10. Ahmed, A., Saber, M., Ahmed, A., Sohaib, Q., Saif, S., Ali, S. The inbluence of antibiotics administra- tion on infection subsequent to dental extraction. (2025). International Journal of Medical Science and Dental Health, 11(02), 72-85. https://doi.org/10.55640/ijmsdh-11-02-05. 11. Ahmed, Ali Saad, et al. Evaluation of Peel Bond Strength between Heat Cured Acrylic Based Den- ture Soft Lining Material and Heat Polymerized Acrylic after Different Acrylic Surface Treatment Methods. 2024. 12. Miri R, Shirzadeh A, Kermani H, Khajavi A. Re- lationship and changes of primary and secondary stability in dental implants: A review. Int J Con- temp Dent Med Rev. 2017;2017:03011. 13. Degidi M, Daprile G, Piattelli A. Primary and secondary stability of implants in different bone types. J Prosthet Dent. 2019;121(5):611-617. 14. Amer A, et al. (2025) Evaluation of Soft Tissue in Rabbit Utilizing Suture and Tissue Glue. Dentis- try 3000. 1:a001 doi:10.5195/d3000.2025.882. 15. Zix, J., Kessler-Liechti, G., & Mericske-Stern, R. Stability measurements of 1-stage implants in the maxilla by means of resonance frequency analysis: a pilot study. Int J Oral Maxillofac Implants 2005; 20. 16.Ahmed, Ali Saad; Ahmed, Rusal Saad; ARAB, Luma Nasrat. The antifungal potential of cinna- mon oil incorporated into a heat-polymerized soft liner. Journal of Dental Materials & Techniques, 2024, 13.3. 17. Zhang Y, Tang X, Zhang Y, Cao C. A network meta-analysis comparing treatment modalities of short and long implants in the posterior maxilla with insufbicient bone height. BMC Oral Health. 2024 Dec 31;24(1):1574. doi: 10.1186/s12903- 024-05377-1. PMID: 39741292; PMCID: PMC11686903. 18. El-Hady AIA, Eid HI, Mohamed SL, Fadl SM. In- bluence of titanium and titanium-zirconium alloy as implant materials on implant stability of maxil- lary implant retained overdenture: a randomized clinical trial. BMC Oral Health. 2024 Aug 6;24(1):902. doi: 10.1186/s12903-024-04692-x. PMID: 39107737; PMCID: PMC11305035. Stability Assessmernt with Immediate Loading Using Blx SlacLve Dental Implant Vol 13, No 1 (2025) DOI 10.5195/d3000.2025.978 http://dentistry3000.pitt.edu 4 Table 1. Males vs. females using independent T-test. Test Comparison Mean ± SD T-Statistic P-Value Signi>icance Independent T-Test Primary Stability (Male) 72.00 ± 3.30 -0.69 0.50 Not Signi>icant Independent T-Test Primary Stability (Female) 72.83 ± 3.40 - - - Independent T-Test Secondary Stability (Male) 81.70 ± 2.83 -0.07 0.95 Not Signi>icant Independent T-Test Secondary Stability (Female) 81.77 ± 2.37 - - - Table 2. Maxilla vs. mandible using independent T- test. Test Comparison Mean ± SD T-Statistic P-Value Signi>icance Independent T-Test Primary Stability (Maxilla) 71.93 ± 3.63 -0.81 0.42 Not Signi>icant Independent T-Test Primary Stability (Mandible) 72.88 ± 3.15 - - - Independent T-Test Secondary Stability (Maxilla) 82.07 ± 2.64 0.19 0.85 Not Signi>icant Independent T-Test Secondary Stability (Mandible) 81.92 ± 2.10 - - - Stability Assessmernt with Immediate Loading Using Blx SlacLve Dental Implant Vol 13, No 1 (2025) DOI 10.5195/d3000.2025.978 http://dentistry3000.pitt.edu 5 Figure 1. The bar graph illustrates the inhibition zones (mm) for Staphylococcus aureus isolates at three-time intervals (T0 (A), T1 (B), T2 (C)), when exposed to six different antibiotics: Amoxicillin, Vancomycin, Ampicillin, Erythromycin, Azithromycin, and Clindamycin. Statistical comparisons between groups are indicated with asterisks (* for p < 0.05, ** for p < 0.01, *** for p < 0.001) and "ns" for non-signi>icant differ- ences. Stability Assessmernt with Immediate Loading Using Blx SlacLve Dental Implant Vol 13, No 1 (2025) DOI 10.5195/d3000.2025.978 http://dentistry3000.pitt.edu 6 Figure 2. The bar graph illustrates the inhibition zones (mm) for Candida albicans isolates at three-time intervals (T0 (A), T1 (B), T2 (C)), when exposed to six antifungal agents: Clotrimazole, Fluconazole, Nystatin, 5-Flucytosine, Caspofungin, and Amphotericin B. Statistical com- parisons between groups are annotated with *** for p < 0.001 and “ns” for non-signi>icant differences.