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P h y s i o l o g i c a l b o n e r e m o d e l i n g o n O s s t e m i m p l a n t s (p = 0.0307). All of the radiographic compari- sons are reported in Table 4. Discussion The aim of this prospective open-cohort study was to investigate, over a 1 year after loading period, the implant survival and success rates of sandblasted and acid-etched bone level implants featuring an 11° Morse taper connection placed in private practice, and to evaluate the physiolog- ical marginal bone remodeling among subgroups of exposed and unexposed subjects. The main limitation of the present study was the short fol- low-up period. Nevertheless, one year after load- ing is sufficient to evaluate the physio logical marginal bone remodeling that was the main topic of this research. In the present study, five out of 243 implants failed over a period of one year after loading, resul ting in a cumulative implant survival rate of 97.9%. No definitive prosthesis failed. One bio- logical and four technical complications were experienced, resulting in a cumulative prosthetic and implant success rate of 97.2 and 99.6%, respec tively. The major clinical conclusion of the present research was that the physiological marginal bone remodeling using Osstem TSIII implants (Osstem) was 0.37 mm within one year after loading, independent of the surgical and pros- thetic protocols. Subgroup analysis showed that smoking, a thin tissue biotype and GBR were associated with a statistically significantly higher MBL. This supports Sgolastra et al.’s con- clusion that smoking seems to be positively as- sociated with higher MBL, implant failure and risk of periimplantitis.19 The results of the present study are in agree- ment with a recent systematic review and meta- analysis that showed that implants placed with an initially thicker periimplant soft tissue have less radiographic MBL in the short-term follow- up.20 The results of this study also demonstrat- ed that implants placed with GBR are as suc- cessful as implants placed into sites with pristine bone. In the present study, the mean MBL expe- rienced around the implants placed in regener- ated bone was slightly higher than that of the implants placed in nongrafted sites. No strong evidence is associated with higher MBL and GBR procedures. Nevertheless, data reported in the present study are consistent with, or slightly lower than, that reported in previous studies.21 Immediate loading and the placement of a defin- itive abutment at implant insertion and never removed have been proven to reduce MBL.22, 23 A possible explanation of this phenomenon could be that most of the immediately loaded implants were placed without a flap, using guided surgery, and received the definitive abutment on the day of surgery, minimizing MBL. High primary implant stability is considered one of the main factors necessary for achieving a predictable high success rate.24–28 Nevertheless, there is no consensus as to the ideal insertion torque required to prevent implant failure. In the present study, two out of seven implants placed at an insertion torque of < 35 N cm failed, reach- ing a statistically significant diference. In the study, 83.5% of the implants were placed at an insertion torque of 45 N cm. The drilling protocol was customized according to the bone density. Conventional preparation was performed in healed sites with a bone density of Type 2 or 3.20 Narrow or halfway adapted preparations were performed in the case of post-extractive implants and poor bone quality, using freehand or guided surgery, respectively. Finally, the osteotome tech- nique was performed only in the maxilla, in order to perform bone spreading. Conclusion Low implant failure and physiological marginal bone remodeling of 0.37 mm within one year after loading can be expected using Osstem TSIII implants in the daily practice. Smoking, GBR and a thin tissue biotype were associated with higher MBL, while immediate loading and placement of the definitive abutment on the day of surgery reduced the MBL. Competing interests The first author (MT) is the Research Project Manager at Osstem AIC, Italy. However, this research was self-supported. Hence, the authors declare that they have no competing interests. Acknowledgments Dr. Marco Tallarico wishes to thank Ms. Gianina Bizduna and Stephany Zambrano for their im- portant clinical assistance. 78 Volume 3 | Issue 1/2017 Journal of Oral Science & Rehabilitation