Nouf Al Humayyani¹, Fahad K Alwthinani¹, Abdulrahman H. Alzahrani¹, Abdulmajeed O Alotaibi¹, Mohamed Y. Abdelfattah^{2, 3,}

Aim: The contemporary research planned to assess the outcomes of implant placement after 2 weeks relaxing of the surgical beds in immediately loaded maxillary implant-supported Kennedy Class IV overdenture with minimally invasive approach. Materials and Methods: 10 patients with missing four or six maxillary anterior teeth opposed by restored or natural dentition were selected. Permitting the strategy of splitting mouth, within the same individual, left side is designated as treatment group (I), and the right serves as the control (II). For Group I (Study group), mucoperiosteal flaps were reflected and drillings were done using 2- and 3.5-mm diameter drills successively to the proper depth marked on the drill (10mm). Profuse irrigation and frequent cleaning of the drills were performed. The mucoperiosteal flaps were repositioned and sutured over the empty hole. After two weeks from the osteotomy, punch technique with 4.0mm diameter tissue punches was applied to expose the previously prepared implant bed of the left side and implants were inserted in place. For group II (control group), Flaps were reflected at the maxillary right side, implant beds were prepared, and implants were inserted immediately. The implants and the abutments in both sides were ready in this stage to be loaded immediately with the denture. 2mm-high locators were chosen, screwed on the implants. Maxillary removable partial overdentures were then evaluated and adjusted to pick up the metal housing using autopolymerizing polymethylmethacrylate. Finally, dentures were inserted, and patients were educated and motivated about the importance of oral hygiene. Assessments were done regarding the clinical assessment of soft tissues, implants' mobility, patient satisfaction and radiographic assessments were done directly after implant drilling, and insertion, and after one, three, six and nine months, to assess marginal bone loss. Statistical analysis of the results were done using Wilcoxin-Signed Rank test. Results: Results showed that soft tissue healing was better for group I rather than for group II throughout the whole follow up periods. A 100% success rate throughout the follow up periods with no signs of movement in the implants for all patients in both groups is a strong indicator of the success and stability of the dental implant procedures. 100% of patients had good scores regarding retention of the prosthesis, 83% good score regarding stability and comfort, and 66% good score regarding ability to chew food. No poor score was reported. While there may not have been immediate differences in marginal bone loss in both groups after one month, distinctions became apparent over a longer follow-up period after three, six, and nine months, with increased bone loss in control group throughout these evaluation periods. Conclusion: The use of implant-retained overdenture in long class IV Kennedy classification cases is considered an accepted treatment modality for immediate function and esthetics. The recommendation to delay implant placement for two weeks after early osteotomy and to use a tissue punch emphasize optimal outcomes, ensuring proper bone healing, and minimizing trauma for a more controlled and aesthetically pleasing result.

immediately loaded implants, relaxed tissue beds, long span Kennedy class IV