PURPOSE: To evaluate the predictability of early and immediate loading protocols
of implants in the posterior mandible and to investigate whether there is a
difference in success rates, survival rates, and peri-implant parameters,
including marginal bone level changes, between loading protocols. MATERIALS AND METHODS: A comprehensive systematic review of the literature was conducted. The selection of publications reporting on human clinical studies was based on predetermined inclusion criteria and was agreed upon by two reviewers. RESULTS: A total of 19 papers were selected: 8 on early loading, 9 addressing immediate loading, and 2 comparing immediate and early loading. Of the 19 studies, 5 were randomized clinical trials and 14 were prospective studies. CONCLUSIONS: Existing literature supports the early loading of microroughened dental implants in the partially edentulous posterior mandible at 6 to 8 weeks in the absence of modifying factors. Therefore, loading within this time frame can be considered routine for the majority of clinical situations in the posterior mandible, either with single crowns or fixed dental prostheses. Immediate loading of microroughened dental implants in the partially edentulous posterior mandible proved to be a viable treatment alternative. Caution is necessary when interpreting published outcomes for immediate loading, as the inclusion exclusion criteria are inconsistent and many subjective confounding factors are evident. Additional studies with longer follow-ups, specifically randomized clinical trials, are needed to consolidate the data for immediate loading. Priority should be given to trials testing immediate loading.
Int J Oral Maxillofac Implants. 2009 Sep-Oct;24(5):896-901.
Bone formation around immediately loaded and submerged dental implants with a modified sandblasted and Acid-etched surface after 4 and 8 weeks: a human
histologic and histomorphometric analysis.
Degidi M, Piattelli A, Shibli JA, Perrotti V, Iezzi G.
Purpose: A high clinical and radiographic level of osseointegration has been
reported for early and immediately loaded (IL) implants. The aim of this study
was to analyze, histologically and histomorphometrically, the bone-titanium
interface of IL and submerged titanium implants that were retrieved at 4 and 8
weeks after placement. Materials and Methods: Four patients underwent
implant was inserted distally in the mandible. In two patients, the additional
implants were put into nonfunctional immediate loading with a fixed provisional
prosthesis on the same day of the implant surgery, whereas in the other two
patients, the implants were left submerged. The implant stability quotients at
implant insertion were 70 and 67 for the submerged implants and 69 and 77 for the IL implants. Before retrieval, the IL implants were clinically osseointegrated
and were not mobile. After 4 and 8 weeks, the four implants (two IL and two
submerged) were retrieved with a 5-mm trephine and processed for histologic
examination. Results: After 4 weeks, the IL implant showed a bone-implant contact percentage (BIC) of 65.6%, while the BIC for the submerged implant was 54.7%. After 8 weeks, the BIC was 76.2% for the IL implant, while for the submerged implant it was 62.3%. Conclusions: Very high BICs were present after 4 and 8 weeks around both submerged and IL implants, with the latter showing a higher quantity of bone. IL did not impede bone formation in the early healing periods.
Int J Oral Maxillofac Implants 2009;24:896-901.
Clin Implant Dent Relat Res. 2009 Feb 13. [Epub ahead of print]
Effect of Implant Design on Preservation of Marginal Bone in the Mandible.
Van de Velde T, Collaert B, Sennerby L, De Bruyn H.
Assistant professor, Department Periodontology and Oral Implantology, Faculty of
Medicine and Health Sciences, Dental School University of Ghent, De Pintelaan
185- P8, Belgium.
ABSTRACT Background: Implant design and surface may have an influence on the marginal bone response during immediate functional loading. Aim: The purpose of this study was to radiographically study the effect of implant design on marginal bone preservation at immediately loaded implants used for prosthetic
rehabilitation of the completely edentulous mandible. Materials and Methods: A
total of 39 patients, previously treated with five implants for support of a
full-arch fixed bridge in the mandible, were included in the study. Either
machined Brånemark(R) implants (Ma) (Nobel Biocare AB, Gothenburg, Sweden) or
surface modified Astra Tech(R) implants with (Mi) or without a microthreaded neck (Ti) (TiOblast, AstraTech AB, Mölndal, Sweden) were used. All fixtures were
loaded with a provisional glass fiber or metal-reinforced screw-retained
restoration within 24 hours. The provisional restorations were replaced by a
12-unit screw-retained metal-ceramic or metal-resin cantilever bridge after 3
months. Bone loss from baseline to 1 year of loading was measured by means of
intraoral radiographs. Only patients with baseline and 1-year radiographs of all
implants were selected for comparison. Statistical analysis was carried out on
both patient and implant levels. Results: The survival rates after 1 year in
function were 98.6, 100, and 100% for the Ma, Ti, and Mi implants, respectively.
The overall mean bone loss after 1 year was 1.03 mm (SD 0.87; range -0.77 to
2.5). The mean bone loss was calculated to 1.52 (SD 0.66) for the Ma group, 0.79
(SD 0.79) for the Ti group, and 0.70 (SD 1.01) for the Mi group. There was a
significant difference between Ma and Ti (p = .023) and between Ma and Mi (p =
.046) groups but not within Ti and Mi implants (p = .70). These conclusions were
also valid when the statistical analysis was performed on implant level.
Conclusions: There is no impact of design and surface on implant survival in the completely edentulous mandible. Bone preservation in immediately loaded implants in the mandible is influenced by implant design and significantly better on surface-modified AstraTech implants compared with machined Brånemark implants. In the mandible, a microthread design of the implant collar does not seem to improve bone preservation.
Aust Dent J. 2009 Sep;54(3):255-61.
Early load mandibular hybrid prosthesis using the Ohio State University acrylic frame requiring no final impression.
Turkyilmaz I, Suarez JC, Company AM, McGlumphy EA.
Department of Prosthodontics, University of Texas Health Science Center at San
Antonio, San Antonio, Texas 78229-3900, USA. firstname.lastname@example.org
BACKGROUND: Although immediate/early loading protocols for dental implants have presented encouraging outcomes, immediate loading procedures may cause discomfort to the patient and may increase the possibility of damage to the surgical site during the impression procedures. The aim of this study was to describe an alternative technique to fabricate a mandibular hybrid prosthesis in three or four days without making any final impression and to evaluate the outcomes of this technique. METHODS: Seven patients aged 41 to 71 years (mean age, 58 +/- 11) were considered for this study. Each patient received five implants for the reconstruction of the edentulous mandible. These implants were placed in the anterior region of an edentulous mandible and restored with a final mandibular hybrid prosthesis in four days using the Ohio State University (OSU) acrylic
frame requiring no final impression procedure. The patients were followed up to
19 months after implant placement. RESULTS: No implants were lost, no technical
complications were observed and only minor marginal bone loss was noted after an
average 15 months. CONCLUSIONS: This clinical study shows that the OSU acrylic
frame, which can easily be customized and accommodates variability in arch form,
may be an alternative method to restore any edentulous mandible with an early
load mandibular hybrid prosthesis.
Clin Implant Dent Relat Res. 2009 Aug 3. [Epub ahead of print]
Immediate Loading of Two Implants with a Mandibular Implant-Retained Overdenture: A New Treatment Protocol.