ΑΝΩ ΓΝΑΘΟΣ j periodontol. 2009 Nov;80(11): 1883-93. Immediate functional loading of dental implants supporting a bar-retained maxillary overdenture: preliminary 12-month results



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Int J Oral Maxillofac Implants. 2009;24 Suppl:158-68.

Implant loading protocols for the partially edentulous posterior mandible.

Cordaro L, Torsello F, Roccuzzo M.

Department of Periodontics and Prosthodontics, Eastman Dental Hospital, Rome,

Italy. lucacordaro@usa.net


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

rehabilitation of the posterior mandible with fixed prostheses, and an additional

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. ilserturkyilmaz@yahoo.com




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.

Stoker GT, Wismeijer D.

Academic Centre for Dentistry Amsterdam (ACTA), Research Institute MOVE,

University of Amsterdam and VU University Amsterdam, Department of Oral

Implantology and Prostodontics, Amsterdam, The Netherlands, and private practice,

implantology and prosthodontic dentistry, Rotterdam (Spijkenisse), The

Netherlands.




ABSTRACT Purpose: The aim of this study was to present the clinical outcomes of

the immediate loading of two bar-splinted implants retaining a mandibular

overdenture. Materials and Methods: In a clinical trial, 124 edentulous patients

were treated according to a new treatment concept, which involves the immediate

loading of two bar-splinted SLActive implants with an implant-retained mandibular

overdenture. The new conventional mandibular denture is used as a template for

implant positioning and as an impression tray, and for mounting the retention

clip by the dental laboratory. At the same day the implants are placed, the

conventional denture is converted into an implant-retained overdenture. During

the healing and evaluation period, resonance frequency analysis (RFA) was

undertaken to assess the effect of loading on implant stability and survival.

Results: The survival rate of the implants was 98.8% during the evaluation period

(12-40 months). Only 3 of the 248 implants were lost. During the healing

(osseointegration) phase, the implant-stability quotient increased significantly

(p = .0001). During the evaluation period, four patients (3%) needed a relining

of their mandibular overdenture, whereas 13 patients (11%) needed relining of the

maxillary denture. Conclusions: Two interconnected implants can be successfully

loaded by a mandibular overdenture at the same day of implant placement with a

high survival rate of the implants. Only a few patients needed additional

relining of the overdenture. Repeated RFA measurements can be useful in gauging

implant stability and survival.



Clin Implant Dent Relat Res. 2009 Apr 23. [Epub ahead of print]

Loading Protocols for Mandibular Implant Overdentures: A Systematic Review with Meta-Analysis.

Alsabeeha N, Atieh M, Payne AG.

PhD student, Oral Implantology Research Group, Sir John Walsh Research Institute,

School of Dentistry, Dunedin, New Zealand.




ABSTRACT Background: Mandibular overdentures are a successful treatment option

for the edentulous patients with long-term predictable outcomes, using

conventional loading protocols. Currently, both early and immediate loading

protocols for mandibular implant overdentures are prevalent in the literature.

Purpose: A systematic review and meta-analysis of the current published

literature on comparative studies using conventional versus either early and/or

immediate loading protocols for mandibular implant overdentures. Materials and

Methods: The review was carried out in accordance with the QUOROM (Quality of

Reporting of Meta-Analyses) guidelines. The PICO (Population, Intervention,

Comparisons, Outcomes) format was used in conjunction with predefined inclusion

criteria. A literature search of PubMed (1969-October 2008), EMBASE (1998-October

2008), the Cochrane Database of Systematic Reviews, and the Cochrane Controlled

Trial Register was conducted. In addition, hand searching through refereed dental

journals was also performed for the years 2000 to 2008. The meta-analysis was

conducted by using the MIX software v.1.7 (Kitasato Clinical Research Center,

Kanagawa, Japan). Results: A total of 191 studies were identified through the

electronic search. After full-text screening and cross-matching with the

predefined inclusion criteria, only 10 studies with a minimum follow-up of 2



years were eligible for inclusion in this review. Of the 10 included studies,

seven have compared the outcome of conventional versus early loading of implants

supporting mandibular overdentures. The remaining three studies, on the other

hand, compared the outcome of conventional versus immediate loading. The

meta-analysis revealed no significant difference in the outcome between

conventional and either early (p = .72) or immediate (p = .08) loading of

implants supporting mandibular implant overdentures. Conclusions: Short-term

outcomes of early or immediate loading protocols for mandibular implant

overdentures achieved comparable success to conventional loading ones. No

evidence was found of long-term studies to support or refute either early or

immediate loading protocols for mandibular implant overdentures.


Clin Implant Dent Relat Res. 2009 Aug 5. [Epub ahead of print]

Immediate Occlusal Loading of Single Lower Molars Using Brånemark System(R) Wide Platform TiUnite Implants: A 5-Year Follow-Up Report of a Prospective Clinical Multicenter Study.

Calandriello R, Tomatis M.

Private practice, Bologna, Italy.


Introduction: Although not essential, molars hold their importance in terms of

functional jaw stability, antagonist opposition, and support of facial height.

Therefore, implant therapy is an attractive concept in molar areas. However,

especially in the posterior mandible, the conventional two-stage surgical

approach to implant therapy was reported to cause higher bone loss and/or higher

implant failures with machined implants because of the peculiar anatomic and

physiologic conditions of this area. As the TiUnite (Nobel Biocare AB, Göteborg,

Sweden) surface results in faster bone healing than with machined-surface

implants, it was hypothesized that this surface would also improve the

performance of wide implants in posterior mandibles. Based on these assumptions,

a protocol for immediately loaded implants for single molar replacement was

developed. Purpose: This paper aimed to report on the clinical and radiological

performance of Brånemark System(R) TiUnite Wide Platform implants supporting

single molars in the lower jaw, loaded immediately and followed for up to 5

years, and to assess if the benefit delivered by oxidized surfaces in the short

run is also present after 5 years. Materials and Methods: The study includes 33

consecutive patients treated between March 2001 and September 2003 and monitored

until September 2008 in two private dental offices. A total of 40 Brånemark



System TiUnite Wide Platform MK III implants were placed. All implants were

provided with provisional crowns in full centric occlusion at the time of

surgery. Patients were clinically and radiologically followed up for up to 5

years. Results: Two implant failed so that the cumulative success rate at 5 years

was 95.0%. The mean marginal bone remodeling (n = 38) expressed as mesial plus

distal value averages was -1.17 mm (SD +/- 0.90) at the 5-year time point.

Conclusion: Although limited by the number of patients treated in accordance with

the protocol described, 5-year results encourage the use of immediately loaded

single lower molars supported by Brånemark System Wide Platform TiUnite implants and further document the clinical advantages of titanium oxidized surfaces.


Int J Prosthodont. 2009 Jul-Aug;22(4):368-73.

Five-year clinical results of immediately loaded dental implants using mandibular overdentures.

Alfadda SA, Attard NJ, David LA.

Department of Prosthodontics, Faculty of Dentistry, University of Toronto,

Ontario, Canada. s.alfadda@utoronto.ca




PURPOSE: The aim of this report is to present the clinical and patient-based

outcomes of an immediate-loading protocol of TiUnite implants with mandibular

overdentures in edentulous patients 5 years following initial placement.

MATERIALS AND METHODS: The study comprised two groups of edentulous patients. In

the experimental group, 35 consecutively treated patients received 70 TiUnite

implants that were loaded immediately, as well as 69 Branemark machined implants

as a backup treatment. One patient received one Branemark implant. The control

group comprised patients who were treated previously with conventional two-stage

implant procedures, but were all case matched to the intervention group and

served as a historical cohort. This group included 42 patients who received 111

Branemark implants. Both groups of patients were treated with overdentures that

were supported with a standardized resilient bar mechanism. Clinical and

patient-based outcomes in the immediate group were recorded for the first 5 years

following the initial placement of implants and were measured at various stages

of treatment using two questionnaires: the Denture Satisfaction Scale and the

Oral Health Impact Profile (OHIP-20). RESULTS: Just over 98% of implants were

found to be successful in both groups (Fisher exact test: P = 1.000). A

statistically significant improvement in patients' total, mandibular, and

functional satisfaction scores was found when comparing baseline data to the data

obtained 5 years following loading in the experimental group (P < .001). There

were no significant differences between the 1- and 5-year total, mandibular, and

functional satisfaction scores, or between baseline and 5-year maxillary denture

satisfaction scores. A statistically significant and positive correlation was

found between baseline and 1-year maxillary satisfaction scores (P = .002). Any

improvement in the patients' quality of life (QoL) was maintained during the

first 5 years of loading. CONCLUSION: The results of this longitudinal study



suggest that immediate loading of two dental implants by means of bar-retained

mandibular overdentures is a predictable treatment option and leads to

substantial improvement in patients' satisfaction and QoL. Importantly, this

mirrors the outcomes found for patients subjected to the more commonly accepted

two-stage implant procedure.


J Oral Maxillofac Surg. 2009 Jun;67(6):1286-93.

Immediate loading of immediate mandibular implants with a full-arch fixed prosthesis: a preliminary study.

Peñarrocha M, Boronat A, Garcia B.

Valencia University Medical and Dental School, Valencia, Spain.

miguel.penarrocha@uv.es


PURPOSE: To determine the survival of immediate dental implants with immediate

loading in the partially edentulous mandible, by use of a full-arch

screw-retained provisional restoration. MATERIALS AND METHODS: Patients who were

partially edentulous in the mandible with indications for extraction of the

remaining teeth and with a minimum follow-up of 12 months after implant placement

were included in the study. They were treated in chronologic order by the



insertion of 6 Defcon dental implants (Impladent, Sentmenat, Spain) subjected to

immediate loading (4 interforaminal and 2 posterior placements). Implants with a

minimum primary stability of 60 implant stability quotient were loaded. All resin

screw-retained prostheses were inserted and loaded with fully functional



occlusion within 24 hours of implant placement. RESULTS: Eleven patients were

treated with immediate implants, although 2 patients were excluded from the study

for having an implant stability quotient value below 60 in at least one of the

implants after surgery and did not undergo restoration with immediate loading.

Fifty-four implants were placed in 9 partially edentulous patients with immediate

loading with a full-arch screw-fixed prosthesis. The patients wore this

provisional prosthesis during the healing period (2 months) without complication

and with a high level of comfort. The survival rate of the implants was 100% at

12 months of follow-up. CONCLUSION: Immediate mandibular loading with immediate

full-arch implant-supported and screw-retained restorations is a viable treatment

alternative, yielding a 100% success rate in this small series of patients.


Shanghai Kou Qiang Yi Xue. 2009 Jun;18(3):333-6.

[Clinical report of early implant-supported mandibular overdenture retained by

conical crowns]

[Article in Chinese]

Zheng QZ, Xie XM, Wang J.

Department of Stomatology, Fengcheng Hospital of Fengxian District, Shanghai

201411, China. zhengweihua0422@sina.com


PURPOSE:To investigate the feasibility and clinical effectiveness of inchoate

implant-supported mandibular overdenture retained by conical crowns. METHODS: In

this study, 25 patients with edentulous mandible were included.All patients

received 4 to 6 dental implants between the mental foramen and impression taking

immediately to make overdenture retained by conical crowns,loading in ten

days.All patients were followed up for 1,3,6,12,24 and 36 months, and then once a

year.The stability of one implants, the state of peri-implant soft-tissue were

recorded, and calculus of peri-implant was cleared. And the state of marginal

bone resorption, osseointegration of implants were examined by X-ray films.

RESULTS: A total of 103 implants were loaded early, 3 failed.The others had

osseointegration,no infection of peri-implant soft-tissue occurred,no implants

exhibited peri-implant radiolucencies. The patients were satisfied with the

outcomes. CONCLUSIONS: The results of this clinical report suggest that immediate

loading of the implants by conical crowns to support overdenture prostheses for

edentulous mandible is feasible between the mental foramen. The short-term

clinical effectiveness of early loading is good.




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