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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ΠΕΡΙΛΗΨΗ ΕΡΓΑΣΙΑΣ (Υπογραμμίσεις από Δ. Τρικεριώτη)


J Periodontol. 2009 Nov;80(11):1883-93.

Immediate functional loading of dental implants supporting a bar-retained maxillary overdenture: preliminary 12-month results.

Pieri F, Aldini NN, Fini M, Marchetti C, Corinaldesi G.

Oral and Maxillofacial Surgery Unit, Department of Dental Sciences, University of

Bologna, Bologna, Italy. checcopieri@yahoo.it

BACKGROUND: The present study evaluated the efficacy of a treatment consisting of

placing and immediately loading implants with a bar-retained overdenture in

edentulous maxillae. METHODS: Twenty-two consecutive patients were treated with

four or five implants rigidly connected with a bar, which were then loaded with a

maxillary overdenture within 48 hours post-surgery. The patients were followed

clinically and radiographically for 1 year after loading. The implant outcome

with regard to survival and success was analyzed. Visual analog scale

questionnaires were used to record patient function and satisfaction before and

after implant treatment. RESULTS: Of the 103 implants, three failed within 1

year. Two implants, although integrated, presented with marginal bone resorption

(MBR) values higher than those proposed for successful implants. Cumulative

survival and success rates of implants were 97.1% and 95.2%, respectively. The

average MBR after 1 year was low (0.78 +/- 0.79 mm). The main prosthetic

complication was the frequent need for complete relining of the prosthesis in the

initial weeks after loading (27.2%). The questionnaire revealed a significant

increase in all comfort, functional, and esthetic parameters (Friedman test; P

<0.0001), except in the cleaning feasibility category; a significant decrease in

satisfaction was observed in this category (Friedman test; P <0.05), indicating

the difficulty patients had in maintaining a high level of oral hygiene.

CONCLUSION: These preliminary results suggest that immediate loading of multiple

implants supporting a bar-retained overdenture may represent a predictable

treatment option for the rehabilitation of the edentulous maxilla.

Int J Oral Maxillofac Implants. 2009;24 Suppl:147-57.

Implant loading protocols for partially edentulous maxillary posterior sites.

Roccuzzo M, Aglietta M, Cordaro L.

Department of Oral and Maxillofacial Surgery, University of Torino, Torino,

Italy. mroccuzzo@iol.it

PURPOSE: To evaluate early and immediate loading of implants in the posterior

maxilla and to investigate whether there is a difference in success rates,

survival rates, and peri-implant parameters, including marginal bone level

changes. 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: Twelve papers were identified on early loading

(two randomized controlled clinical trials [RCTs] and 10 prospective case series

studies). Six papers were found on immediate loading (one RCT, four prospective

case series, and one retrospective study). CONCLUSIONS: Under certain

circumstances it is possible to successfully load dental implants in the

posterior maxilla early or immediately after their placement in selected

patients. The success rate appears to be technique sensitive, although no study

has directly assessed this. A high degree of primary implant stability (high

value of insertion torque) and implant surface characteristics play an important

role. It is not possible to draw evidence-based conclusions concerning

contraindications, threshold values for implant stability, bone quality and

quantity needed, or impact of occlusal loading forces. As for the impact of the

surgical technique on implant outcome in different bone densities, no studies

prove significant superior results with one technique over another. Well-designed

RCTs with a large number of patients are necessary to make early/immediate

loading protocols in posterior maxilla evidence based, but ethical and practical

considerations may limit the real possibility of such studies in the near future.

Clin Oral Implants Res. 2009 Jul;20(7):645-59.

Immediate restoration/loading of immediately placed single implants: is it an effective bimodal approach?

Atieh MA, Payne AG, Duncan WJ, Cullinan MP.

Oral Implantology Research Group, Sir John Walsh Research Institute, School of

Dentistry, University of Otago, Dunedin, New Zealand.

OBJECTIVE: To compare systematically the survival and radiographic marginal bone

level changes of two immediate implant protocols in the aesthetic region;

immediate single implant restoration/loading in extraction sockets (the bimodal

approach) compared with the same in healed sites. MATERIAL AND METHODS: A

literature search of electronic databases, Cochrane Oral Health Group's Trials

Register, National Research Register, conference proceedings and abstracts was

performed without language restriction up to 1 August 2008. Hand searching

included several dental journals and authors were contacted for missing

information. Controlled trials that compared immediate restoration/loading of

single implants placed in extraction sites with those placed in healed sites were

selected. The meta-analysis was prepared according to the guidelines of the

Quality of Reporting of Meta-analyses statement. The data were analysed using

RevMan version 5.0 software. A fixed effects model was chosen with standardized

mean differences for continuous data, and risk ratios for dichotomous data with

95% confidence intervals. RESULTS: Ten studies with 629 implants were included.

Immediate single implant restoration/loading in extraction sockets in the

aesthetic zone was associated with significantly higher risk of implant failure

(risk ratio of 3.62, 95% confidence interval 1.15-11.45, P=0.03). However, the

bimodal approach showed favourable marginal bone changes after 1 year.

CONCLUSION: The review and meta-analysis supported the potential advantages

offered by this bimodal approach, but indicated a higher risk when compared with

immediate restoration/loading in healed ridges. Further long-term,

well-conducted, randomized-controlled studies are needed to confirm the validity

of this treatment option.

Int J Oral Maxillofac Implants. 2009;24 Suppl:169-79.

Implant loading protocols for the partially edentulous esthetic zone.

Grütter L, Belser UC.

Department of Fixed Prosthodontics and Occlusion, School of Dental Medicine,

University of Geneva, Rue Barthelemy-Menn 19, Geneva CH-1205, Switzerland.


PURPOSE: The scientific evidence related to different or novel implant loading

(primary objective) and directly associated implant placement (secondary

objective) protocols developed for the anterior maxillae of partially edentulous

patients was reviewed. MATERIALS AND METHODS: A comprehensive search of

electronic databases and a hand search of six relevant journals was performed.

The principal outcome variables were implant survival, implant success, and

esthetic appearance. Concerning esthetic treatment outcomes, articles were

specifically screened for the presence of objective evaluation parameters and

patient satisfaction assessment. RESULTS: The analysis of the literature on

immediately restored or conventionally loaded implants in the esthetic zone

revealed an initial survival rate of 97.3% after 1 year (10 prospective cohort

studies and one case series). For periods of 1 to 5 years, the survival rate was

96.7%. These survival rates are consistent with previous reports on more

traditional loading modalities. However, for immediately placed implants with

immediate restoration and occlusal loading, the survival rate dropped by

approximately 10% (four studies). Success criteria such as stable crestal bone

levels, soft tissue recession, and probing depth could not be evaluated on the

basis of the available literature. CONCLUSION: There is a paucity of prospective

cohort studies addressing patient-centered outcomes. No parameters specific to

immediate loading protocols were available for evaluation. In order to validate

or reject such implant protocols for use in the esthetically sensitive anterior

maxilla, long-term clinical trials should routinely include objective esthetic

criteria that comprehensively embrace the pertinent elements of "pink and white

esthetics" in the form of readily used indices.

J Craniofac Surg. 2009 Nov;20(6):2143-9.

Clinical viability for immediate loading of dental implants: part II—treatment alternatives.

Goiato MC, Pellizzer EP, Barão VA, dos Santos DM, de Carvalho BM, Magro-Filho O, Garcia IR Jr.

UNESP--Araçatuba Dental School, Dental Materials and Prosthodontics, José

Bonifácio, 1193, Araçatuba, São Paulo 16015-050, Brazil. goiato@foa.unesp.br

The treatment with implants aims to obtain a direct interface between bone and

implant. The implant is kept load-free during 4 to 6 months in the 2-stage

procedure, which is considered a requisite for osseointegration. However, this

period is based on empirical principles and uncomfortable for patient. So, the

immediate loading protocol was suggested to submit implants to occlusal function

after placement. This protocol has been applied for several conditions of

edentulism. The aim of this study was to evaluate the treatment alternatives for

immediate loading of complete and partial edentulous patients. In general, the

studies have demonstrated high previsibility for rehabilitation of complete

edentulous arches with full-arch, implant-supported prosthesis. The

rehabilitation with immediate loading for maxillary overdenture is questionable

because there is no longitudinal study in literature. The studies with partial

edentulous arches have demonstrated high success rates for implants placed in the

mandibular and maxillary anterior region. Additional care is recommended for

posterior region mainly in the maxillary arch, and further studies are suggested

to corroborate this treatment.

J Periodontol. 2009 Sep;80(9):1393-8.

Immediate versus one-stage restoration of small-diameter implants for a single missing maxillary lateral incisor: a 3-year randomized clinical trial.

Degidi M, Nardi D, Piattelli A.

Dental School, University of Chieti-Pescara, Chieti, Italy.

BACKGROUND: The aim of this study was to compare the bone loss pattern and soft

tissue healing of immediately versus one-stage loaded 3.0-mm-diameter implants in

cases involving a single missing lateral maxillary incisor. METHODS: Sixty

patients with a missing lateral incisor in the maxilla were randomized to one of

the treatments: 30 patients in the immediate-restoration group and 30 patients in

the one-stage group. All implants were placed in healed sites and had to be

inserted with a torque >25 Ncm. The implants in the immediate-restoration group

were fitted with a non-occluding temporary crown on the day of surgery. Both

groups received a full occluding final crown 6 months after surgery. Mean

marginal bone loss, probing depth, and bleeding on probing were assessed at 6-,

12-, 24-, and 36-month follow-up examinations by a masked examiner. RESULTS:

Sixty 3.0-mm-diameter implants were placed between July 2003 and February 2006;

27 (45.0%) were in men, and 33 (55.0%) were in women. All implants

osseointegrated and were clinically stable at the 6-month follow-up. No

statistically significant differences were observed for bleeding or plaque index.

No implant fractures occurred. At the 36-month follow-up, the accumulated mean

marginal bone loss and probing depth were 0.85 +/- 0.71 mm and 1.91 +/- 0.59 mm, respectively, for the immediate-loading group (n = 30) and 0.75 +/- 0.63 mm and 2.27 +/- 0.81 mm, respectively, for the one-stage group (n = 30). There was no statistically significant difference (P >0.05) for the tested outcome measures

between the two procedures. CONCLUSIONS: In the rehabilitation of a single

missing lateral maxillary incisor, no statistically significant difference was

assessed between immediately and one-stage restored small-diameter implants with

regard to implant survival, mean marginal bone loss, and probing depth.

Three-millimeter-diameter implants proved to be a predictable treatment option in

our test and control groups if a strict clinical protocol was followed.

J Prosthet Dent. 2009 Oct;102(4):211-5.

Immediate loading and customized restoration of a single implant in the maxillary esthetic zone: a clinical report.

den Hartog L, Raghoebar GM, Stellingsma K, Meijer HJ.

Department of Oral and Maxillofacial Surgery, University Medical Center

Groningen, University of Groningen, Groningen, the Netherlands.


The replacement of a single missing anterior tooth with an implant-supported

crown is a demanding therapy. This report describes a treatment in which an

anterior maxillary implant was immediately restored with a provisional

restoration. During the provisional phase, an optimal emergence profile was

created by adjusting the provisional restoration. An impression was made with an

individually fabricated impression post for an accurate reproduction of the

established emergence profile and, finally, a screw-retained all-ceramic crown

was placed. By implementing this protocol, an optimal definitive result could be

achieved, together with immediate patient satisfaction. However, cooperation

among several disciplines and careful patient selection were required.

Implant Dent. 2009 Aug;18(4):326-33.

Immediate provisionalization of single-tooth implants in fresh-extraction sites at the maxillary esthetic zone: up to 6 years of follow-up.

Mijiritsky E, Mardinger O, Mazor Z, Chaushu G.

Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela

Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel.

AIM: Numerous studies demonstrate successful immediate loading of dental

implants. The purpose of this study was to evaluate the long-term survival of

single-tooth implants immediately placed in fresh extraction sites at the

anterior maxilla with immediate infraocclusion-provisional restorations and

nonfunctional immediately loading. METHODS: A total of 24 implants were placed in

16 patients. The fixed provisional restorations were connected to a prefabricated

plastic abutment. Occlusal contacts were avoided. Follow-up starting at

implantation day ranged from 24 to 72 months with a mean of 40.7 months. RESULTS:

One implant failed 1 month after placement due to the unscrewing of a temporary

abutment that resulted in implant overload. Overall implant survival rate

resulted in 95.8%. The mean marginal bone loss increased by 0.9 +/- 1.1 mm.

starting from implant placement. CONCLUSIONS: Within the limits of this study,

the data indicate that nonfunctional immediate loading of single-tooth implants

placed in fresh extraction sites in the anterior maxilla can result in successful

implant integration and stable peri-implant conditions up to 6 years.

Int J Periodontics Restorative Dent. 2009 Apr;29(2):161-7.

Tapered implants: from indications to advantages.

Alves CC, Neves M.

Faculty of Dentistry, University of Porto, Portugal. celia.alves@manuelneves.com

Tapered implants have become routine for immediate implant placement after tooth

extraction. It seemed extremely advantageous to use tapered implants in type 4

bone, where primary stability is difficult to achieve. The authors established a

surgical implant placement protocol to be followed in areas where type 4 bone and

a wide bone ridge (> or = 8 mm) are present. First, preparation of the implant

alveolus is done exclusively with cylindric osteotomes, rather than with conic

osteotomes or drills. The final cylindric osteotome is the same diameter as the

final twist drill that is typically used in conventional preparation of the

implant alveolus (a technique that can be adapted for use with other tapered

implants). Because of the self-tapping property of the tapered implant used and

its anatomic design, this surgical technique was developed to optimize the bone

compaction effect in the coronal third of the implant, improving bone density and

providing better primary stability values (> or = 70 ISO, via the Osstell Mentor

device). With the strong bond that is created between the implant surface and the

surrounding bone using this technique, immediate loading can be predictable, even

in the type 4 bone that is commonly found in the maxillary tuberosity.

J Oral Implantol. 2009;35(4):164-75.

Sinus grafting with a natural fluorohydroxyapatite for immediate load: a studywith histologic analysis and histomorphometry.

Lee CY, Rohrer MD, Prasad HS, Stover JD, Suzuki JB.


The goal of this retrospective study was to evaluate the survival rates of dental

implants placed in sinuses grafted with a 50:50 composite ratio of autogenous

bone and a natural flourohydroxyapatite (FHA) combined with platelet-rich plasma

(PRP) using an immediate-load protocol. The authors hypothesized that a 50:50

composite ratio of FHA and autogenous bone combined with PRP would permit

immediate loading without compromising implant survival rates. Eleven patients

with bilateral partial edentulism of the posterior maxilla were enrolled in this

retrospective study. Autogenous bone used in the graft procedure was harvested

from the tibia of the left lower extremity. Each patient was grafted with a 50:50

composite ratio of autogenous bone and FHA. Membranes were not used to cover the

lateral wall osteotomy site. Platelet-rich plasma was added to the graft material

to accelerate and enhance bone regeneration. Four to 6 months after the grafting

procedure, 37 hydroxyapatite-coated dental implants were surgically placed and

immediately loaded between 72 hours and 5 days later with custom titanium

abutments and acrylic provisional restorations placed out of functional

occlusion. Six months later, definitive ceramometal restorations were cemented on

to the custom abutments. Patients were observed over a 52-week period. The

overall implant survival rate was 97.3%. Histologic and histomorphometric

analysis of core samples revealed formation of new vital bone in different graft

specimens ranging from 23% to 34%. In each core bone sample, 100% of the bone

sample was determined to be vital. In the grafted maxillary sinus, the natural

FHA combined with autogenous bone in a 50:50 composite ratio with PRP is a

suitable graft material permitting immediate load without compromising implant

survival rates while decreasing the overall healing time.


Implant Dent. 2009 Dec;18(6):530-8.

A prospective follow-up study of 44 mandibular immediately loaded implants using

resonance frequency analysis: preliminary 1-year results.

Melo AC, de Freitas MC, Bernardes SR, de Mattias Sartori IA, Bassi AP, Thomé G.

Department of Orthodontics, Latin-American Institute of Dental Research and

Education-ILAPEO, Curitiba, Brazil. amelo@ilapeo.com.br

PURPOSE: This clinical study aimed to evaluate initial, 4-months, and 1-year

stability of immediately loaded dental implants inserted according to a protocol

of lower rehabilitation with prefabricated bars. MATERIALS AND METHODS: The sample was composed of 11 edentulous patients. In each patient, 4 interforaminal implants were inserted. Immediately after implant installation, resonance frequency analysis (RFA) for each fixation was registered as well as after 4 months and 1 year with the prosthetic bar removed as it is a screwed system.

RESULTS: The clinical implant survival rate was 100%. The RFA showed an increase in stability after 4 months from 64.09 +/- 6.48 to 64.31 +/- 4.96 and 1 year, 67.11 +/- 4.37. The analysis of variance showed a statistically significant

result (P = 0.015) among implant stability quotient values for the different

periods evaluated. Tukey test results showed statistically significant

differences between 1-year results and the initial periods but there was no

statistically significant difference between initial and 4-month results (P >

0.05). CONCLUSION: These preliminary 1-year results indicate that immediate

loading of mandibular dental implants using the studied prefabricated bars

protocol is a reliable treatment as it is in accordance with the results

described in the literature for other similar techniques.

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