Interventions for replacing missing teeth: different times for loading dental implants.
Esposito M, Grusovin MG, Achille H, Coulthard P, Worthington HV.
Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH.
J Am Dent Assoc. 2009 Mar;140(3):340-1.
Cochrane Database Syst Rev. 2007;(2):CD003878.
implants are conventionally kept load-free during the healing period. During
healing removable prostheses are used, however many patients find these temporary
prostheses rather uncomfortable and it would be beneficial if the healing period
could be shortened without jeopardizing implant success. Nowadays immediately and
early loaded implants are commonly used in mandibles (lower jaws) of good bone
quality. It would be useful to know whether there is a difference in success
rates between immediately or early loaded implants compared with conventionally
loaded implants. OBJECTIVES: To evaluate the efficacy of (1) immediate (within 1
week), early (between 1 week and 2 months), and conventional (after 2 months)
loading of osseointegrated implants, and of (2) immediate occlusal versus
non-occlusal loading during the bone healing phase. SEARCH STRATEGY: The Cochrane
Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched.
Handsearching included several dental journals. Authors of all identified trials,
an Internet discussion group and 55 dental implant manufacturers were contacted
to find unpublished randomised controlled trials (RCTs). The last electronic
search was conducted on 4 June 2008. SELECTION CRITERIA: All RCTs of root-form
osseointegrated dental implants, having a follow up of 4 months to 1 year,
comparing the same implant type immediately, early and conventionally loaded or
occlusally and non-occlusally loaded. Outcome measures were: prosthesis and
implant failures and radiographic marginal bone level changes. DATA COLLECTION
AND ANALYSIS: Data were independently extracted, in duplicate, by two review
authors. Authors were contacted for details of randomisation and withdrawals and
a quality assessment was carried out. The Cochrane Collaboration's statistical
guidelines were followed. MAIN RESULTS: Thirty RCTs were identified and 22 trials
including 976 participants in total were included. Twelve trials compared
immediate versus conventional loading, three early versus conventional loading,
six immediate versus early loading, and one occlusally versus non-occlusally
loaded implants. On a patient, rather than per implant basis, there were no
statistically significant differences for any of the meta-analyses. AUTHORS'
CONCLUSIONS: It is possible to successfully load dental implants immediately or
Gallucci GO, Morton D, Weber HP.
Department of Restorative Dentistry and Biomaterials Science, Harvard School of
Dental Medicine, 188 Longwood Avenue, Boston, Massachusetts 02115, USA.
scientific and clinical evidence related to implant-supported rehabilitations for
the edentulous mandible and maxilla. MATERIALS AND METHODS: An electronic search
of several databases covered the period from January 1966 to August 2008. From a
total of 2,371 publications identified from this search, 61 articles fulfilled
the inclusion criteria set forth by the authors. It should be noted that only
studies reporting on implants with rough surfaces were included in the final
selection for this review. RESULTS: Selected studies yielded data from 2,278
patients and 9,701 implants. Studies were grouped according to treatment protocol
and prosthodontic design, and results on conventional, early, and immediate
loading were assessed separately for fixed and removable dental prostheses.
Clinical recommendations for implant loading in different edentulous indications
were established using a special validation protocol of the published scientific
and clinical evidence for different treatment modalities, which was based on the
study design, sample size, and outcome homogeneity between studies. CONCLUSIONS:
The highest level of scientific and clinical validation was found for
conventional loading with mandibular overdentures and maxillary fixed dental
prostheses. Insufficient scientific or clinical documentation/validation was
found for immediate loading of maxillary overdentures, as well as for immediate
loading of immediately placed implants combined with fixed or removable dental
prostheses in either jaw. All other loading protocols for edentulous arches
showed different degrees of clinical documentation.
Immediate loading with single implant crowns: a systematic review and meta-analysis.
Gonzalo M, Atieh MA, Atieh AH, Payne AG, Duncan WJ.
Sir John Walsh Research Institute, School of Dentistry, Univeristy of Otago,
Dunedin, New Zealand. firstname.lastname@example.org
compared immediate to conventional loading of single implant crowns was conducted
and the overall treatment effect was estimated. MATERIALS AND METHODS: MEDLINE,
the Cochrane Controlled Trials Register, and bibliographies of relevant primary
and review articles were searched. Randomized and nonrandomized controlled
studies that compared immediate with conventional loading of single implant
crowns were selected according to strict criteria. From the 105 articles
screened, five studies with 248 implants were analyzed. The meta-analysis was
prepared in accordance with the Quality of Reporting of Meta-analyses (QUOROM)
statement. Descriptive and outcome data were extracted using specially designed
data extraction forms. The data were entered into MIX software for meta-analysis
using a fixed effects model, relative risk, and 95% confidence interval (CI).
RESULTS: Immediate loading of single implant crowns was associated with a
significantly higher risk of implant failure (relative risk: 5.07, 95% CI: 2.00
to 12.84, P < .001). Pooling of randomized controlled trials showed similar
results, although the difference was not statistically significant. Immediate
nonocclusal loading was also associated with worse outcomes when compared to
conventional loading (relative risk: 4.76, 95% CI: 1.74 to 13.02, P = .002).
CONCLUSIONS: This systematic review and meta-analysis shows that better outcomes
are currently achieved using conventional loading of single implants with crowns,
as opposed to immediately loaded ones, which are at a higher risk of failure.
Further adequately powered clinical trials are needed. Caution with immediate
loading of implants with crowns as a standard of care for single tooth
replacement is recommended.
Irinakis T, Wiebe C.
implant during placement in different types of bone, immediate placement into
sockets, and in grafted bone. The torque at time of placement serves as an
indication of initial stability, which is accepted as an important factor for
implant osseointegration and immediate loading. Within a 13-month period, 140
NobelActive implants in 84 consecutive patients were placed into types I-IV bone
in fresh sockets, and into grafted bone (both in maxillary sinuses and on the
facial alveolar surfaces where bone had been lost). The final torque was measured
with a manual torque control wrench as manufactured by Nobel Biocare for clinical
use with this type of implant. One hundred forty implants with 3.5 to 5 mm
diameters and 10 to 15 mm lengths were placed in different types of bone, either
as delayed or immediate implants into fresh extraction sockets. These implants
levels. This may indicate they are more favorably suited to early
provisionalization and loading. Soft bone (type IV) did not seem to decrease
significantly the torque of insertion of these implants. Further longer term
studies are needed to investigate whether this indeed makes these implants more
suited for early provisionalization and loading than traditional root form. Long
term studies are also needed to investigate maintenance of bone levels
surrounding these implants.
Danza M, Guidi R, Carinci F.
Dental School, University of Chieti, Chieti, Italy.
placement of dental implants into extraction sockets achieving excellent results
with a 2-stage surgical procedure. Recently, immediate loading has become an
emerging technique as it has been documented to be a successful and a time saving
procedure. As regard, few reports are available for the possibility of
immediate/early loading of implants placed in fresh extraction sockets. In
addition, they are based on limited series with short follow-up. Thus, we decided
to perform a retrospective study on a series of postextractive spiral family
implants (SFIs). MATERIALS AND METHODS: In the period May 2004 to November 2007,
133 SFIs were inserted in fresh extraction sockets. The mean follow-up was 12
months. Several host-, surgery-, and implant-related factors were investigated
and Kaplan-Meier algorithm and Cox regression were used to detect those variables
associated with the clinical outcome. RESULTS: Because only 7 of 133 implants
were lost (i.e., survival rate, 94.7%) and no statistical differences were
detected among the studied variables, no, or reduced, marginal bone loss was
considered as an indicator of success rate to evaluate the effect of several
host-, surgery-, and implants-related factors. Also, in this case no variable has
impact on clinical outcome. CONCLUSION: It was demonstrated that postextractive
SFIs have a high survival and success rate that are similar to those reported in
previous studies of 2-stage procedures or in immediate loading implants inserted
in healed bone.
Clinical outcome of submerged vs. non-submerged implants placed in fresh extraction sockets.
Cordaro L, Torsello F, Roccuzzo M.
Eastman Dental Hospital, Department of Periodontics and Implant Dentistry, Rome,
submerged vs. non-submerged tapered implants placed into fresh extraction
sockets. Materials and methods: A prospective, controlled, multicenter,
randomized, clinical trial has been performed in two centers in Rome and Torino
(Italy). Thirty healthy patients were recruited according to the following
inclusion criteria: need for an immediate post extraction implant, ages between
18 and 70, horizontal defect depth <2 mm, smokers <10 cigarettes/day and absence
of any circumstance or condition that could represent contraindications to
implant surgery. The patients were randomly allocated to submerged or
non-submerged treatment groups immediately after flap elevation and tooth
extraction. Submerged implants were exposed 8 weeks after the first surgery; all
implants were loaded with provisional restorations 12 weeks after the first
surgery and with definitive restoration 12 weeks thereafter. Clinical and
radiographic parameters were evaluated at baseline, at implant loading and at the
1-year follow-up visit. Results: The results showed statistically significant
differences between the two groups in the mean value of keratinized tissue (KT)
height after surgery that was significantly reduced for submerged implants when
compared with transmucosal implants (mean reduction of KT at year follow-up: T
group 0.2 mm, S group 1.3 mm; P=0.007). Conclusion: Similar outcomes were found
for submerged and non-submerged implants placed in fresh extraction sockets with
a horizontal peri-implant defect smaller than 2 mm, except for a reduction of KT
in the submerged group. Either with a submerged or a non-submerged procedure, 1
mm of mean soft tissue recession is seen after 1 year when compared with the
Dierens M, Collaert B, Deschepper E, Browaeys H, Klinge B, De Bruyn H.
Department of Periodontology and Oral Implantology, Faculty of Medicine and
Health Sciences, Dental School, University of Ghent, Ghent, Belgium.
psychological problems. Objectives: To evaluate patient-centered outcomes of
full-arch screw-retained rehabilitation on immediately loaded implants. MATERIAL
AND METHODS: Fifty patients treated with Astra Tech(TM) implants answered
self-administered questionnaires on a visual analogue scale (VAS) 100 mm scale or
with multiple-choice or open questions: at baseline, 1 week, 3 or 6 months and 1
year. Changes of VAS in time were analyzed using mixed models for repeated
measures, adjusting for gender, age and jaw; comparison of cross-sectional
parameters between jaws was performed with the Mann-Whitney U- or chi(2)-test,
all at the 0.05 significance level. RESULTS: The median calculated general
satisfaction score increased from 40.25 (mean=40.9; SD=23.82; range=0-95) at
baseline to 98.25 (mean=95.3; SD=6.68; range=74-100) after 1 year. Overall
comfort, eating comfort, speaking comfort and perceived esthetics improved
significantly within 1 week after surgery and immediate provisionalization. This
did not change significantly until the final bridge was installed after 3 months
(mandible) or 6 months (maxilla), when a further significant improvement was
demonstrated. The most common postoperative complication was swelling, especially
in the maxilla. The importance of one-stage surgery and immediate loading was
rated very high by patients before treatment, especially in the mandible. The
main reason for choosing fixed prosthetics was eating comfort. Phonetics and
esthetics were more important in the maxilla than in the mandible. CONCLUSION:
Immediate full-arch rehabilitation yeilds an instant significant improvement in
general patient satisfaction and self-perceived factors related to comfort,
function and esthetics. Eating comfort is the main concern for the patient and
shows the highest improvement. Postoperative complications are limited and
patients considered immediate loading important.
Immediate occlusal loading of immediately placed implants supporting fixed restorations in completely edentulous arches: a 1-year prospective pilot study.
Pieri F, Aldini NN, Fini M, Corinaldesi G.
Department of Odontostomatological Sciences, University of Bologna, Bologna,
treatment consisting of the immediate loading of implants placed immediately
after tooth extraction in full-arch restorations and to compare the clinical and
radiographic outcomes of implants placed in healed versus postextraction sites in
the same group of patients. METHODS: Twenty-three patients who needed full-arch
restorations were treated. One hundred forty-four implants were placed: 59 after
stability measurements (ISQ) and radiographs of the marginal bone level (MBL)
change were performed at prosthesis delivery and after 1 year. RESULTS: One
implant in the test group and one implant in the control group failed, giving a
1-year follow-up, no statistically significant difference was found between the
control and test sites with respect to MBL change (0.47 +/- 0.18 mm versus 0.57
+/- 0.27 mm) or mean ISQ values (62.24 +/- 1.92 versus 61.34 +/- 2.15).
CONCLUSION: These preliminary data suggest that immediate loading of implants
placed immediately after extraction may be a viable treatment option for
edentulous arches when implants are stable at insertion and are rigidly splinted
with screw-retained titanium-resin prostheses.
Li W, Chow J, Hui E, Lee PK, Chow R.
Associated Brånemark Osseointegration Center, Hong Kong. email@example.com
loading of completely edentulous maxillas and mandibles by fixed provisional
prostheses and to compare cumulative survival rates between maxillas and
mandibles. Contributing factors including implant diameter, system,
configuration, type of abutment connections, position of implants, and insertion
torque values were investigated. PATIENTS AND METHODS: From August 2001 to March
2007, 111 patients treated at the Associated Brånemark Osseointegration Center,
Hong Kong, who received immediate functional loading of implants by fixed
completely edentulous provisional prostheses were reviewed. Marginal bone changes
were measured. RESULTS: There were 48 edentulous maxillas and 85 edentulous
mandibles, in total 133 arches. Twenty-two cases received simultaneous maxillary
and mandibular rehabilitation. Three hundred nineteen implants were used for the
maxilla and 371 implants for the mandible, in total 690 implants. A mean of 6.65
fixtures was used to reconstruct an edentulous maxilla and a mean of 4.36
implants for an edentulous mandible. The mean follow-up period was 29.5 months,
ranging from 11.5 to 71 months. Six hundred seventy-two of 690 implants (97.4%)
had been followed up at least 1 year. Four implants failed in the maxilla and 5
implants failed in the mandible. Mean marginal bone loss was 0.07 mm after 1
year. Mean failure time was 2.89 months postoperatively (range, 2 to 5 mo). In
those failed implants, maximal insertion torque values were significantly lower
than those of successful ones. The immediate loading protocol constituted
difference in survival rates between the maxillas and mandibles (chi(2) exact
test, P = 1.000). The implant survival rate was found to be not related to
implant diameter, system, configuration, type of abutment connections, and
position of implants (P > .05). CONCLUSION: The immediate loading protocol by
fixed provisional prostheses proved to be an effective method in restoring
completely edentulous maxillas and mandibles, and the maximal insertion torque
value may be a prognostic factor in determining success.
The one-model technique: a new method for immediate loading with fixed prostheses in edentulous or potentially edentulous jaws.
Biscaro L, Becattelli A, Poggio PM, Soattin M, Rossini F.
implants with a fixed prosthesis in edentulous or potentially edentulous arches.
In these situations, one of the main problems associated with immediate loading
is the transfer of diagnostic information to the master cast. This technique
takes advantage of an acrylic resin transfer plate that enables transfer of the
study cast information to the master cast. Without any intrasurgical impression
or any recording of the maxillomandibular relationship during or after surgery,
construction of an adequate esthetic and functional fixed prosthesis is possible
on the basis of diagnostic information acquired in the presurgical phase. The
methodology is always applicable when there is an indication for immediate
loading of implants. The rationale and guidelines for the successful use of this
technique in edentulous or potentially edentulous arches are discussed and
illustrated with a clinical case.
Survival of Immediately Provisionalized Dental Implants: A Case-Control Study with up to 5 Years Follow-Up.
Laviv A, Levin L, Usiel Y, Schwartz-Arad D.
Resident, Department of Oral and Maxillofacial Surgery, Hadassah Medical Center,
immediately provisionalized implants with up to 5 years follow-up. Materials and
Methods: The study consisted of 226 patients, 113 consecutive patients with
immediately provisionalized dental implants (cases) and 113 randomly selected,
age-, gender-, and implant position-matched controls with conventional late
implant loading. Survival rate and incidence of complications were recorded.
Results: Follow-up ranged from 6 to 60 months. Smoking was reported by 20.8% of
patients. Maxillary incisors and mandibular lateral incisors were the most common
areas for implant placement. Conventionally loaded implants were narrower (p =
.03) and shorter (p = .001). Immediate implantation into a fresh extraction
socket was performed in 69% of the cases and in 36.3% of the controls (p = .001).
Implant survival rate was 96.5%. Of the eight failed implants, six were
immediately provisionalized and two were conventionally loaded. No statistically
significant difference was found in survival rates between groups (p > 0.05).
Five of the failed implants (case group) were immediately loaded implants placed
in fresh extraction sockets. Conclusion: Immediate implant provisionalization