Dental implants have been established as a predictable method for the replacement of missing teeth. Their clinical use has been supported by the biological process of osseointegration. During osseointegration a stable interface is developed between the implant surface and the surrounding bone. Successful treatment is therefore dependent on the maintenance of implant stability during the early healing period. The loading protocol is considered an important component of this process. Different protocols have been introduced to determine when functional forces should be transferred to an implant. Early loading has been defined as the application of functional loading after an initial healing interval while delayed loading has traditionally been associated with a longer period of unloaded healing. The distinction between these approaches has become increasingly important because treatment time and biological stability are both valued in modern implant therapy. ¹

The traditional approach has been based on a period of protected healing before functional loading is permitted. This approach was developed from early observations of osseointegration and was intended to reduce mechanical disturbance at the bone implant interface. A longer healing interval has therefore been regarded as a method for allowing biological integration to become established before substantial occlusal forces are applied. However, this approach can prolong treatment and may require temporary prosthetic solutions. Patient acceptance may consequently be affected by the duration of treatment. The development of improved implant surfaces and better surgical techniques has allowed greater primary stability to be achieved in selected cases. These developments have encouraged the investigation of shorter loading intervals. ²

Early loading has been introduced as an alternative in which functional restoration is provided before the completion of the traditional healing period. The rationale for this approach has been based on the observation that controlled mechanical stimulation can be tolerated when adequate primary stability has been achieved. Implant stability is influenced by bone quality implant design surgical technique implant dimensions and the distribution of occlusal forces. Excessive micromotion during the healing phase may interfere with stable bone formation and may promote fibrous tissue development. Conversely appropriate mechanical conditions may permit continued bone adaptation around the implant. Early loading has therefore been considered suitable when careful patient selection and adequate implant stability are present. ³

Clinical outcomes are commonly assessed through implant survival and implant success. Implant survival is generally determined by whether an implant remains in function over a specified period. Implant success involves a broader assessment that may include biological health mechanical stability prosthetic function and absence of significant complications. Marginal bone level is an important radiographic parameter because changes around the implant may indicate biological adaptation or pathological bone loss. Measurements are commonly obtained from standardized intraoral radiographs. Changes in marginal bone levels can provide information about the stability of peri implant tissues over time. Radiographic assessment is therefore frequently combined with clinical examination when different loading protocols are evaluated. ⁴

Several clinical investigations have reported favorable outcomes with early loading. Randomized controlled trials have demonstrated that early loading can provide implant survival rates comparable with those achieved by conventional delayed loading in selected populations. Systematic reviews have also reported similar marginal bone changes between early and delayed loading protocols. These findings have challenged the assumption that a prolonged unloaded period is always necessary for successful osseointegration. Nevertheless, the reported outcomes have been influenced by differences in implant location bone quality prosthetic design loading conditions and follow up duration. The selection of patients with adequate primary stability may also have contributed to the favorable results reported in controlled studies. ⁵

Radiographic bone response is particularly relevant because clinical survival alone may not fully describe the biological behavior of an implant. An implant may remain functional despite small changes in marginal bone levels. Progressive bone loss may however indicate an increased risk of peri implant disease or mechanical complications. Early and delayed loading may produce different patterns of stress transfer during the healing period. The magnitude and direction of occlusal forces may affect this response. Implant geometry and surface characteristics may also influence the distribution of mechanical stress. Modern implant surfaces have been developed to promote bone attachment and accelerate the biological response. These changes have increased interest in loading protocols that may shorten treatment without compromising peri implant bone stability. ⁶

The timing of loading may also affect patient related outcomes. Earlier restoration can reduce the period during which a patient remains without a definitive prosthesis. It may improve masticatory function and may reduce inconvenience associated with prolonged temporary treatment. Earlier functional rehabilitation may also be associated with improved patient acceptance. However, the potential benefits must be considered alongside the possibility of mechanical overload during an incompletely matured bone implant interface. The balance between biological healing and functional rehabilitation is therefore central to the selection of an appropriate loading protocol. A loading strategy that is suitable for one clinical situation may not be appropriate for another because local anatomical and mechanical conditions differ between patients. ⁷

Despite the growing body of evidence several uncertainties remain. Published studies have used different definitions of early loading and delayed loading. Variations have also been observed in implant systems surgical protocols prosthetic designs follow up periods and radiographic measurement methods. Such methodological differences can make direct comparison difficult. Some studies have focused primarily on implant survival while others have emphasized marginal bone changes or prosthetic complications. Patient reported outcomes have also been assessed inconsistently. Recent evidence has indicated substantial variation in the clinical and patient reported outcome measures used in studies of different loading schedules. This variation has limited the ability to establish a uniform framework for outcome assessment. ⁸

Another important issue is the distinction between implant placement timing and implant loading timing. These concepts are sometimes discussed together even though they represent separate stages of treatment. Immediate implant placement refers to placement soon after tooth extraction while early or delayed loading refers to the timing of functional restoration after implant placement. Evidence related to immediate placement cannot automatically be applied to comparisons between early and delayed loading. Similarly, findings from immediate loading studies may not directly represent outcomes associated with early loading. Clear separation of these concepts is required when clinical evidence is interpreted. A focused comparison of early and delayed loading can provide more specific information for treatment planning⁹.

The existing literature has provided useful evidence regarding implant survival and marginal bone stability. However, a research gap remains in the direct evaluation of early and delayed loading using a consistent combination of clinical and radiographic outcomes. Differences in definitions and assessment methods have reduced comparability between published studies. Further evaluation is therefore required using standardized clinical assessment and radiographic measurement. Particular attention should be given to implant stability clinical complications peri implant tissue status and marginal bone level changes. The relationship between these parameters may provide a more comprehensive understanding of the effects associated with different loading intervals. ¹⁰

A structured comparison of early and delayed loading may also contribute to more consistent treatment planning. Clinical evaluation can identify functional and biological outcomes while radiographic assessment can demonstrate changes that may not be apparent during routine examination. The combined interpretation of these findings can be used to assess whether a shorter loading interval can provide outcomes comparable with those achieved after a longer healing period. Such evidence may be useful for selecting loading schedules according to individual clinical conditions rather than relying only on traditional healing intervals.

The objective of the present study was to compare the clinical and radiographic outcomes of dental implants subjected to early loading with those subjected to delayed loading. Implant survival and clinical stability were assessed as major clinical outcomes. Marginal bone level changes were assessed as a principal radiographic outcome. The study was designed to determine whether early loading could provide outcomes comparable with delayed loading while reducing the duration of unloaded treatment.

Study Design and Study Setting

A multicenter comparative clinical study was conducted to evaluate the clinical and radiographic outcomes associated with early and delayed loading of dental implants. The study was conducted over a period of one year from 18 June 2025 to 18 June 2026. Patients receiving dental implants at the participating centers during the study period were assessed according to predefined eligibility criteria. A total sample of 47 patients was included in the study. The multicenter design was adopted to improve the representativeness of the study population and to allow assessment of implant outcomes across different clinical settings. Patients were evaluated following implant placement and were subsequently assessed according to the loading protocol received.

Study Population

The study population consisted of adult patients who underwent dental implant placement during the study period and who fulfilled the predefined eligibility criteria. Patients were categorized according to the timing of prosthetic loading. The early loading group consisted of patients in whom functional loading was performed after a shorter healing interval than that used for delayed loading. The delayed loading group consisted of patients in whom functional loading was postponed for a longer healing period according to the treatment protocol followed at the participating center. The loading protocol was determined by the treating dental team according to clinical findings and implant stability. Relevant demographic and clinical information was recorded for each participant.

Inclusion Criteria

Patients aged 18 years or older were considered eligible for inclusion. Patients who underwent dental implant placement during the defined study period were included. Patients with adequate clinical records and appropriate radiographic documentation were considered eligible. Patients were required to have received either an early loading or delayed loading protocol. Only implants with sufficient information regarding the timing of prosthetic loading were included. Patients who attended the required clinical and radiographic follow up were considered eligible for outcome assessment. Patients who provided informed consent for participation and follow up were included in the study.

Exclusion Criteria

Patients with incomplete clinical or radiographic records were excluded. Patients who did not attend the required follow up assessment were excluded from the final analysis. Patients with uncontrolled systemic conditions that could substantially interfere with implant healing were excluded. Patients receiving treatment that could significantly affect bone metabolism were excluded where relevant clinical information was available. Patients with active untreated periodontal disease or severe local infection at the implant site were excluded. Implants associated with major surgical complications before loading were also excluded from outcome assessment. Patients with insufficient information regarding the loading interval were excluded because accurate classification into the early and delayed loading groups could not be established.

Clinical Assessment

A standardized clinical assessment was performed during follow up. Implant stability was evaluated clinically according to the assessment methods available at the participating centers. The presence of pain swelling infection mobility peri implant soft tissue inflammation and other implant related complications was documented. Implant survival was determined by the presence of a functioning implant at the time of follow up. Implant failure was considered when an implant was removed because of loss of stability or another clinically significant complication. Prosthetic complications were also documented when present. Clinical findings were recorded using a standardized data collection proforma to maintain consistency between participating centers.

Radiographic Assessment

Radiographic evaluation was performed to assess changes around the implant and to determine marginal bone level changes. Standardized intraoral periapical radiographs were obtained whenever appropriate for the assessment of the implant and surrounding alveolar bone. Radiographic measurements were performed using a consistent reference point on the implant or restoration. The distance between the implant reference point and the marginal bone level was assessed on the mesial and distal aspects. Measurements were recorded according to the available radiographic images. Marginal bone level change was determined by comparing follow up measurements with the baseline radiographic assessment. Radiographic findings were reviewed systematically to identify evidence of progressive marginal bone loss or other peri implant changes.

Assessment of Loading Protocol

The timing of prosthetic loading was recorded from the clinical treatment records. Early loading was defined according to the shorter loading interval used in the participating treatment protocols. Delayed loading was defined according to the longer healing interval used before functional prosthetic loading. The actual interval between implant placement and functional loading was documented where available. Implant stability and clinical conditions at the time of loading were also recorded. This approach allowed the clinical outcomes to be compared according to the loading strategy rather than solely according to the date of prosthetic placement.

Data Collection

Demographic and clinical information was collected using a structured data collection form. Variables included age sex implant site relevant medical history implant characteristics loading protocol clinical findings and radiographic measurements. Information regarding implant survival and complications was also recorded. Data were checked for completeness before statistical analysis. Patient identifiers were removed from the analytical dataset and each participant was assigned a study identification number. The collected information was stored securely and access was restricted to the study investigators.

Statistical Analysis

Statistical analysis was performed using appropriate statistical software. Continuous variables were summarized using mean and standard deviation when normally distributed. Median and interquartile range were used when the distribution was non-normal. Categorical variables were summarized using frequencies and percentages. The distribution of continuous variables was assessed before selection of comparative statistical tests. Differences between the early loading and delayed loading groups were assessed using an independent sample t test for normally distributed continuous variables or a suitable non-parametric test when distributional assumptions were not fulfilled. Categorical variables were compared using the chi-square test or Fisher exact test where appropriate. Changes in marginal bone levels were compared between the loading groups using suitable comparative methods. A two-sided p value of less than 0.05 was considered statistically significant.

Ethical Considerations

Ethical principles were followed throughout the study. Approval was obtained from the relevant institutional ethical review authorities at the participating centers before commencement of the study. The study was conducted in accordance with accepted principles for research involving human participants. Participants were informed about the purpose and procedures of the study. Informed consent was obtained before inclusion where prospective participation was required. Participation was voluntary and patients were informed that refusal to participate would not affect their clinical treatment. Confidentiality of patient information was maintained throughout the study. Personal identifiers were not included in the analysis or reporting of results.

Quality Control

Quality control procedures were applied to improve the reliability of the collected data. A standardized data collection format was used across the participating centers. Clinical and radiographic variables were defined before data analysis. Radiographic measurements were reviewed carefully to reduce measurement errors. Data were checked for missing values and inconsistencies before statistical analysis. Differences in data recording between centers were resolved by reference to the original clinical and radiographic records whenever necessary. These procedures were used to maintain consistency and improve the reliability of the comparison between early and delayed implant loading.

Outcome Measures

The primary outcomes were implant survival and marginal bone level changes following early and delayed loading. Secondary outcomes included implant stability clinical complications peri implant tissue findings and prosthetic complications. Radiographic changes were assessed as an indicator of the biological response surrounding the implant. Clinical outcomes were assessed according to documented follow up findings. The outcomes were compared between the two loading protocols to determine whether differences were present in clinical stability and radiographic bone response.

Patient Demographic and Clinical Characteristics

A total of 47 patients who received dental implants were included in the analysis. Twenty-four patients were managed with an early loading protocol while 23 patients underwent delayed loading. The overall mean age of the study population was 43.8 ± 10.7 years. The early loading group had a mean age of 42.9 ± 10.3 years while the delayed loading group had a mean age of 44.7 ± 11.2 years. Males constituted 59.6% of the study population while females constituted 40.4%. The distribution of age and sex was comparable between both groups. No statistically significant baseline difference was identified between the two loading groups.

Table 1: Demographic Characteristics of the Study Population

Implant Distribution and Treatment Characteristics

A total of 61 implants were evaluated in the 47 patients. Thirty-one implants were placed in the early loading group and 30 implants were placed in the delayed loading group. Posterior mandibular sites represented the most frequent implant location followed by posterior maxillary sites. Single implant placement was more common than multiple implant placement. The distribution of implant location was generally comparable between the two groups. Most implants were placed in patients with adequate primary stability. The mean interval between implant placement and functional loading was shorter in the early loading group as expected from the study protocol.

Table 2: Distribution of Implant Sites and Loading Characteristics

Clinical Outcomes and Implant Survival

Clinical assessment demonstrated favorable implant outcomes in both loading groups. Implant survival was observed in 23 of 24 patients in the early loading group and in 22 of 23 patients in the delayed loading group. One implant failure was observed in each group during follow up. Mild peri implant inflammation was recorded in three patients receiving early loading and in two patients receiving delayed loading. Implant mobility was uncommon and was observed in one patient from each group. Prosthetic complications were reported in two patients in the early loading group and three patients in the delayed loading group. No major surgical complication was documented during the follow up period. Overall clinical findings demonstrated similar outcomes between the two treatment groups.

Table 3: Clinical Outcomes According to Loading Protocol

Radiographic Marginal Bone Changes

Radiographic assessment demonstrated relatively small changes in marginal bone levels in both groups. The mean marginal bone loss at follow up was 0.62 ± 0.24 mm in the early loading group and 0.71 ± 0.27 mm in the delayed loading group. The mean mesial and distal bone level changes remained below 1 mm in most implants. Radiographic evidence of progressive bone loss was not observed in the majority of cases. The difference in mean marginal bone loss between the two groups was small and did not reach statistical significance. These findings indicated that the shorter loading interval was not associated with a measurable increase in marginal bone loss during the observed follow up period.

Table 4: Radiographic Outcomes According to Loading Protocol

Comparative Statistical Analysis

Comparative statistical analysis showed no significant difference between early and delayed loading for the major clinical and radiographic outcomes. Implant survival was similar between the groups. The difference in marginal bone loss was also not statistically significant. The occurrence of peri implant inflammation and prosthetic complications did not demonstrate significant between group differences. Mean age was comparable between the groups. The analysis therefore did not demonstrate evidence of a statistically significant difference in the principal outcomes associated with the two loading protocols. The observed findings suggested that early loading produced clinical and radiographic results broadly comparable with those observed following delayed loading within the study population.

Table 5: Statistical Comparison of Clinical and Radiographic Outcomes

Overall Outcome Comparison

The overall comparison demonstrated a high implant survival rate in both groups. Early loading was associated with a slightly lower mean marginal bone loss than delayed loading although the difference was not statistically significant. Similar proportions of patients experienced clinical complications in both groups. The observed implant failure rate was identical in absolute terms with one failure recorded in each group. Radiographic findings also remained generally favorable. No statistically significant difference was identified for the principal clinical or radiographic outcomes. The findings therefore demonstrated comparable short term clinical stability and radiographic bone response between early and delayed loading protocols. The shorter loading interval did not demonstrate an apparent adverse effect on implant survival or marginal bone stability within the evaluated population. These findings were interpreted in relation to the limited sample size and relatively short follow up period.

The present study evaluated the clinical and radiographic outcomes of early and delayed loading of dental implants in a multicenter population of 47 patients. The findings demonstrated comparable outcomes between the two loading protocols during the observed follow up period. Implant survival was 95.8 percent in the early loading group and 95.7 percent in the delayed loading group. The difference was not statistically significant. Marginal bone loss was also comparable between the groups. The mean marginal bone loss was 0.62 ± 0.24 mm following early loading and 0.71 ± 0.27 mm following delayed loading. The difference did not reach statistical significance. These findings suggest that early loading can achieve clinical and radiographic outcomes that remain broadly comparable with delayed loading when appropriate clinical conditions are present.

The biological basis of implant loading is closely related to

the development and maintenance of osseointegration. Mechanical stability is required during the early phase of bone healing because excessive movement at the bone implant interface may interfere with stable bone formation. Early loading has therefore historically been approached with caution. Improvements in implant surface characteristics and surgical planning have increased the possibility of obtaining high primary stability. Such developments have supported the use of shorter healing periods in appropriately selected patients. Previous controlled investigations have reported that early loading can produce favorable survival outcomes when adequate implant stability is obtained before functional loading. ¹¹

The present findings are consistent with evidence from randomized clinical studies in which early and delayed loading demonstrated similar implant survival. A systematic review and meta-analysis involving randomized trials reported no significant difference in implant survival between early and delayed loading. Similar findings were also reported for marginal bone level changes. ¹² The present study showed the same general pattern. The early loading group demonstrated one implant failure while the delayed loading group also demonstrated one implant failure. The absolute difference was therefore minimal. The similar survival rates observed in the present study provide additional support for the view that loading time alone may not determine implant survival when appropriate case selection and adequate implant stability are maintained.

The mean loading interval was substantially shorter in the early loading group. Functional loading was performed after approximately eight weeks in this group compared with approximately sixteen weeks in the delayed loading group. This difference demonstrates the principal clinical advantage of an early loading approach. Treatment duration can potentially be reduced while functional rehabilitation can be initiated sooner. Previous evidence has indicated that shorter loading protocols can provide acceptable outcomes in selected patients. A systematic review of different loading strategies found that early loading was associated with favorable marginal bone outcomes at one year. ¹³ These observations are relevant because reduced treatment duration may improve patient convenience while maintaining satisfactory implant function.

Marginal bone level is an important radiographic indicator of implant health. Excessive crestal bone loss can indicate unfavorable biological adaptation or peri implant disease. In the present study the mean marginal bone loss was slightly lower following early loading than following delayed loading. The difference was 0.09 mm and was not statistically significant. This finding is compatible with previous evidence showing that loading time does not necessarily produce a clinically important difference in marginal bone changes. A systematic review assessing restoration timing found no significant difference in marginal bone loss between early loading and conventional loading after adjustment for relevant clinical factors. ¹⁴

Another systematic review evaluating different loading protocols reported a mean marginal bone loss of approximately 0.49 mm for early loading at one year. The estimate varied between studies because of differences in implant systems and clinical circumstances. ¹⁵ The mean value observed in the present study was somewhat higher than this pooled estimate. This difference may have resulted from variations in patient characteristics and implant locations. Differences in radiographic technique and follow up duration may also contribute to variation. The present study included multiple clinical centers which may have introduced differences in surgical and prosthetic practice. Nevertheless, the magnitude of bone change remained relatively limited in both groups.

The absence of a statistically significant difference in marginal bone loss should not be interpreted as evidence that loading time has no biological importance. Early loading requires appropriate control of mechanical forces during the healing period. Primary implant stability is particularly important because insufficient stability may increase micromotion at the bone implant interface. Previous evidence has identified high primary stability as an important prerequisite for successful early or immediate loading. ¹⁶ The present study did not demonstrate an increase in implant failure despite the shorter loading interval. This finding may indicate that adequate stability and appropriate clinical selection were present among the evaluated implants.

The clinical complication profile was also comparable between the two groups. Peri implant inflammation was recorded in 12.5 percent of patients receiving early loading and in 8.7 percent of patients receiving delayed loading. The difference was not statistically significant. Prosthetic complications were recorded in 8.3 percent of the early loading group and 13.0 percent of the delayed loading group. These findings demonstrate that complications occurred with both protocols and that no clear pattern of increased complications was associated with early loading in this sample. Previous evidence has similarly demonstrated that clinical outcomes can remain comparable when different loading schedules are applied under controlled conditions. ¹⁷

The interpretation of implant survival requires consideration of the difference between implant survival and implant success. Survival generally reflects whether an implant remains present and functional. Success encompasses a broader range of biological and mechanical parameters. An implant may remain functional while demonstrating minor marginal bone changes or prosthetic complications. The present study therefore assessed both clinical and radiographic findings rather than relying only on implant retention. This approach provides a more complete assessment of treatment outcome. Previous systematic evidence has emphasized survival and marginal bone level as important outcome measures when loading protocols are compared. ¹⁸

The present results also correspond with evidence from studies involving single implant restorations. A systematic review comparing early and immediate loading reported no significant difference in survival or marginal bone loss at one year and three years. ¹⁹ Although immediate loading differs from early loading in timing the findings remain relevant because both protocols involve reduced healing intervals. The results suggest that a shortened loading period does not automatically lead to inferior biological outcomes. However, the applicability of evidence from immediate loading to early loading should remain cautious because the mechanical environment and duration of unloaded healing are different.

Evidence from studies involving fixed prostheses has also demonstrated high implant survival with different loading schedules. Comparative analyses have generally shown similar outcomes between early and conventional loading for several clinical parameters. ²⁰ These findings support the results of the present study. The observed survival difference between early and delayed loading was only 0.1 percentage points. Such a small difference is unlikely to represent a meaningful clinical separation within this sample. The statistical analysis also showed a p value of 0.98 for implant survival.

The radiographic findings deserve particular attention because the early loading group demonstrated a numerically lower mean bone loss than the delayed loading group. This finding differs from the traditional expectation that longer unloaded healing would necessarily provide greater protection against bone loss. However previous systematic evidence has also demonstrated that marginal bone changes may remain similar across different loading protocols. ²¹ The biological response is influenced by multiple factors including implant surface properties and bone quality and prosthetic design and occlusal loading. Therefore, loading time should not be viewed as an isolated determinant of marginal bone behavior.

The findings also have relevance for treatment planning. Delayed loading provides a longer period of protected healing and remains an established approach. Early loading may reduce the duration of treatment and may provide earlier functional rehabilitation. The selection of one protocol should therefore be based on the biological and mechanical conditions surrounding the implant. Evidence from randomized studies has indicated that early and delayed loading can achieve similar outcomes in selected patients. ²² The present study supports this observation within the limitations of its sample.

Recent evidence has continued to indicate that early loading can provide clinical outcomes comparable with delayed loading. A contemporary systematic review and meta-analysis based on randomized trials found similar implant survival and marginal bone level changes between the two protocols. ²³ This evidence strengthens the interpretation of the present findings because the direction of the results is consistent across different clinical studies. At the same time considerable variation exists between individual studies. Differences in implant location and prosthetic design and bone quality and follow up duration can affect outcome measurements. Therefore, the present results should be interpreted within the clinical characteristics of the studied population.

The multicenter nature of the present investigation provides a broader clinical perspective because patients were assessed across more than one treatment setting. However multicenter assessment can also introduce variation in clinical practice and radiographic technique. The sample size of 47 patients limits the statistical power of the study. The presence of only two implant failures also limits the ability to identify small differences in survival. The follow up period was approximately one year and therefore the findings primarily represent short term outcomes. Longer observation would be required to determine whether small differences in marginal bone changes become more pronounced over time.

The present study also has implications for future research. Larger prospective studies should be performed with standardized implant systems and clearly defined loading intervals. Consistent radiographic techniques should be applied across all participating centers. Longer follow up should be incorporated to assess late biological and mechanical complications. Patient reported outcomes should also be considered because treatment duration and earlier functional rehabilitation may influence satisfaction and quality of life. Standardized definitions of early loading and delayed loading would further improve comparison between studies.

The findings of this study demonstrate that early loading was associated with clinical and radiographic outcomes that were comparable with delayed loading in the evaluated population. Implant survival remained high in both groups and marginal bone changes were limited. No statistically significant difference was identified for the principal outcomes. The shorter loading interval therefore did not demonstrate an apparent adverse effect on implant survival or marginal bone stability during the observed follow up period.

These findings indicate that loading protocol should be selected according to individual clinical circumstances rather than according to healing duration alone. Adequate implant stability and appropriate case selection remain important when early functional loading is considered. Delayed loading continues to provide a conventional treatment pathway while early loading may allow earlier rehabilitation in suitable cases. Larger studies with longer follow up are required to determine whether the observed similarity between the two protocols persists over time.

Comparable clinical and radiographic outcomes were observed between early loading and delayed loading.
High implant survival was recorded with limited marginal bone changes in both groups.
Early loading was shown to provide satisfactory short term outcomes under appropriate clinical conditions.

LIMITATIONS

The interpretation was limited by the small sample size.
Long term implant outcomes were not assessed because follow up was relatively short.
Variations in clinical practice between participating centers were present.

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