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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Cochrane Database Syst Rev. 2009 Jan 21;(1):CD003878.

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.


Comment in:

J Am Dent Assoc. 2009 Mar;140(3):340-1.

Update of:

Cochrane Database Syst Rev. 2007;(2):CD003878.

BACKGROUND: To minimize the risk of implant failure, osseointegrated dental

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to find unpublished randomised controlled trials (RCTs).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

early after their placement in selected patients, though not all clinicians may

achieve optimal results. It is unclear whether it is beneficial to avoid occlusal

contacts during the osseointegration phase. Trends suggest that immediately

loaded implants fail more often than those conventionally loaded, but less

commonly than those loaded early. If a clinician wishes to load the implants

early, it might be wiser to load them immediately (within 1 week) rather than

waiting for 1 or 2 months. A high degree of primary implant stability (high value

of insertion torque) seems to be one of the prerequisites for a successful

immediate/early loading procedure. More well designed RCTs are needed and should

be reported according to the CONSORT guidelines (www.consort-statement.org/).

Int J Oral Maxillofac Implants. 2009;24 Suppl:132-46.

Loading protocols for dental implants in edentulous patients.

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.


PURPOSE: The objective of this systematic review was to present the current

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.

Int J Prosthodont. 2009 Jul-Aug;22(4):378-87.

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. maatieh@gmail.com

PURPOSE: A systematic review and meta-analysis of studies that specifically

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.

J Oral Implantol. 2009;35(6):277-82.

Initial torque stability of a new bone condensing dental implant. A cohort study of 140 consecutively placed implants.

Irinakis T, Wiebe C.

Abstract The aim of this paper was to determine the torque resistance of this new

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

demonstrated a mean torque stability value of 50.8 Ncm. The average insertion

torque for delayed implants was 49.7 Ncm. For immediate implants the average

torque was 52.6 Ncm. Placement into soft bone was also favorable at an average of

47.9 Ncm. Typical straight walled and tapered implants generally exhibit 10 to 35

Ncm insertion torques. The NobelActive implant consistently reaches higher torque

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.

Implant Dent. 2009 Jun;18(3):270-8.

Spiral family implants inserted in postextraction bone sites.

Danza M, Guidi R, Carinci F.

Dental School, University of Chieti, Chieti, Italy.

PURPOSE: In the last 2 decades, several investigators have reported immediate

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.

Clin Oral Implants Res. 2009 Aug 30. [Epub ahead of print]

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,


Abstract Aim: The aim of this study was to compare the clinical outcome of

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

pre-extraction situation.

Clin Oral Implants Res. 2009 Oct;20(10):1070-7. Epub 2009 Aug 30.

Patient-centered outcome of immediately loaded implants in the rehabilitation of fully edentulous jaws.

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.

INTRODUCTION: Edentulism often involves functional, esthetic, phonetic and

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.

J Periodontol. 2009 Mar;80(3):411-21.

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,

Italy. checcopieri@yahoo.it

BACKGROUND: The aims of this pilot study were to evaluate the efficacy of

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

tooth extraction (test group) and 85 in healed sites (control group). Within 48

to 72 hours of implant placement, nine maxillary and 15 mandibular arches

received screw-retained fixed prostheses, consisting of a titanium framework

fabricated with a computer-aided design and manufacturing techniques and

composite resin teeth. The insertion torque for implants was >or=30 Ncm. Implant

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

cumulative success rate of 98.6%; the prosthesis survival rate was 100%. At the

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.

J Oral Maxillofac Surg. 2009 Dec;67(12):2653-62.

Retrospective study on immediate functional loading of edentulous maxillas and mandibles with 690 implants, up to 71 months of follow-up.

Li W, Chow J, Hui E, Lee PK, Chow R.

Associated Brånemark Osseointegration Center, Hong Kong. ksliwilliam@hotmail.com

PURPOSE: The aim of the present study was to describe immediate functional

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

cumulative survival rates of 98.7% for the maxilla and 98.7% for the mandible,

with an overall cumulative survival rate of 98.7%. There was no significant

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.

Int J Periodontics Restorative Dent. 2009 Jun;29(3):307-13.

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.


This article examines a new prosthetic procedure for the immediate loading of

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.

Clin Implant Dent Relat Res. 2009 Feb 13. [Epub ahead of print]

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,

Jerusalem, Israel.

ABSTRACT Purpose: The aim of this study was to evaluate the survival rate of

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

achieved similar high success rates compared with the conventional, delayed

approach. As immediate implant provisionalization is mainly desired in the

anterior region, the high success rates are encouraging.

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