62 Chapter 3.1 3.3 Soft Tissue Outcomes Holgers Grade 0 was recorded in 54.7% of visits across the entire study group. During the 12-month follow-up, adverse skin reactions (Holgers grade 2–4) were observed in 4.4% of all postoperative visits, occurring in 22 individuals (19.1%). No association with surgical technique, age, sex, or BMI was identified. Pain was reported by one individual at the second postoperative review. Keloid scarring and scar overgrowth occurred in four (2.2%) implant systems; however, no revision surgery was required for any implant. 3.4 Implant Stability Quotient Three implants had missing ISQ recordings from the time of implantation and 63 implants were missing ISQ data at the second stage surgery (Table 2). Single-stage procedures (n 9) did not have implant-level ISQ recorded at either surgical stage. Therefore, ISQ was measured in 164 implants at the implant level, i.e., first- stage surgery and 101 implants at the second stage surgery before abutment placement. Irrespective of the implant length the mean ISQH and ISQL demonstrated a nonsignificant increase between the first and second stages of 2 and 3.1 points, respectively (Table 2). With respect to the abutment ISQ, the mean ISQH increased for the 6-, 9-, and 12-mm abutments by 2.5, 9.5, and 10.8, respectively (Fig. 1/Table 3). However, this increase was only statistically significant within the 9- mm cohort and from the 3 month review onwards. Combining the entire cohort of abutment length with an overall increase in ISQH of 8.43, statistical significance was reached at 3 months. The mean ISQL increased by 5.2 and 10.1 for the 6- and 9-mm abutments, respectively, whereas it decreased by 3.9 in the 12-mm group. These changes were only statistically significant in the 9-mm group. Overall, an increase in ISQL of 9.03 was observed (Fig. 1/ Table 3). 3.5 Relationship Between Fixture Failure, BMI, and ISQ The mean BMI centile of the fixture failure patients (22.7th centile SD, 7.9) did not differ from the mean for the entire cohort (23rd centile, SD 13.3). Statistical analysis of the relationship between atraumatic fixture failure and the ISQ was not performed due to the small sample size (n 5). However, no obvious correlation or relationship could be identified between ISQ at either fixture of abutment level and subsequent failure, the ISQ at all visits for each of these implants as demonstrated in Table 4.
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