2.4. Surgical Procedure
M-D, allergic, pain
Standard routine surgical procedures were applied. As a preoperative medication, all patients received Amoxicillin (875 mg orally twice daily or Clindamycin 600 mg if allergic to penicillin) for 5 days, with an initial dose (2 tablets) administered 2 h before surgery. The same surgeon, a specialist in implantology with many years of experience in this field, installed all implants. Firstly, patients were anesthetized with local infiltrative anesthesia using 2% Articaine (DFL Ltd., Rio de Janeiro, Brazil). A mucosal incision was then made up to the periosteal level, the full-thickness mucoperiosteal tissue was elevated, and the osteotomies were performed using the sequence of drills indicated by the manufacturer (in this case, the same for both implant models) for each implant diameter used. A total of 100 implants were installed, with diameters of 3.5 mm (For drilling, an implant motor and a 20:1 reduction contra-angle (Bien-Air Surgery SA, Le Noirmont, Switzerland) were used under external irrigation with a 0.9% saline solution. All implants were installed using surgical guides, and the wounds were sutured. All implants were installed using the motor at a rotation of 30 RPM; a torque value was obtained after implant placement. Ketoprofen (200 mg/day) and Paracetamol (750 mg, three times per day) were administered for pain relief for three days after the surgeries. All implants were positioned 2 mm intra-bone (subcrestal) with a healing abutment, which in all cases was 1 mm outside the mucosa. After 30 days, the healing abutment was removed, and an impression was performed to install a provisional crown within 45 days after the surgery.After the implant insertion, the ISQ value was measured using the Ostell Mentor device (Integration Diagnostics AB, Göteborg, Sweden) with a magnetic sensor type 49 (Smartpeg, Integration Diagnostics AB, Göteborg, Sweden), which was screwed into each implant and tightened to approximately 5 Ncm. The ISQ values were measured immediately after the implant insertion into the bone (T1—baseline) at 30 days (T2) and 45 days (T3) after surgeries. The measurements were obtained in two directions: buccolingual (B-L) and mesiodistal (M-D). Additionally, for the presentation of ISQ values evaluating the distribution of these data, an average was made between the measurements obtained in both directions (B-L and M-D). The scale provided by the device manufacturer (Osstell) was used to present the distribution and evaluation of the number of implants between each range of the ISQ values [