Simultaneous immediate placement and immediate loading of implants in the maxilla: a case presentation

The standard three- to six-month healing time for implants is no longer an absolute. In selected cases, it is now possible to load the implants in fewer than two months; and, in some cases, immediate loading is possible. This article contains a case study showing that with careful patient selection, immediate loading appears to be an acceptable technique.     

Success of immediate loading implants compared to conventionally‐loaded implants: a literature review

The purpose of this systematic literature review was to compare the clinical performance between conventionally‐ (delayed) and immediately‐loaded implants. A literature search of studies published between 1995 and 2012 was performed using several electronic databases and the following key words: “immediate loading”, “dental implants”, “immediate function”, “early loading”, “oral implants”, “immediate restoration”, and “systematic review” was performed. The electronic search was supplemented with hand‐searching in dental journals and cross‐referencing within the selected articles. Studies were considered for inclusion if they analyzed the success of the immediate loading protocol for implants, with emphasis given to randomized, controlled clinical trials. Among the clinical studies extracted from the literature, 120 studies met the inclusion criteria and were included in this systematic review. These studies included trials that involved yielded consistent results of success rates of immediately‐loaded implants comparable to those known from conventionally‐loaded implants, which were subjected to the immediate loading protocol or other loading protocols. According to the findings, there is evidence to suggest that immediate loading protocols demonstrate high implant survival rates and could be cautiously recommended for certain clinical situations. However, studies with a high level of evidence, especially randomized, controlled trials, performed over a longer timeframe are required to show a clear benefit over conventional and other loading types.     

Immediate loading of implants in the edentulous maxilla

The overall aim of this thesis was to investigate different therapeutic strategies in treatment of the edentulous maxilla with dental implants and their importance for treatment outcome. The introduction of one-stage surgery, in place of two-stage surgery, was a paradigm shift in the area of implant treatment since submerged implant healing underneath the mucosa was considered a prerequisite for healing in the original concept. The advantages of a one-stage method are that a second surgery is unnecessary, costs are lower, and patients complain less about the surgical procedures. The development of implant treatment, regardless of whether it is performed in the mandible or the maxilla, strives to shorten the period from implant placement to implant loading. For the edentulous patient--due to esthetic, economical, or psychological reasons--shortening this time and thus avoiding a long period of wearing a transitional removable prosthesis is advantageous. Use of conventional one-stage surgery makes possible and is a prerequisite for immediate loading of implants. Successful treatment outcome has been demonstrated for immediate loading of implants in the mandible, but documentation of the method in the maxilla is still sparse. Two prospective clinical studies compared (i) one- and two-stage surgery and (ii) immediate and conventional loading in patients consecutively treated in the edentulous maxilla with implant-supported fixed prostheses. The first study found that the cumulative survival rate (CSR) after one-stage surgery performed according to a conventional protocol was consistent with two-stage protocol CSRs reported in previous studies. The second study evaluated an immediate loading protocol that provided patients with interim fixed prostheses within 24 hours after implant placement. A comparison of the studies found no significant difference in CSRs. But it was found that when a conventional protocol was used, transitional removable prostheses could traumatize the bone-implant interface during healing by adverse loading on the implants, which pierced the mucosa. Moreover, splinting the implants immediately after surgery with an interim fixed prosthesis might protect them from adverse loading. In a finite element analysis comparing uncoupled and splinted implants--imitations of the clinical situations in the two studies--splinted implants drastically reduced stresses in the bone tissue surrounding the implant, which might facilitate bone healing. Two factors considered important for a successful treatment outcome, especially when loading implants immediately, are (i) jawbone quality and (ii) primary implant stability at placement. In implant literature, bone quality is generally equivalent to bone density. Results of the third clinical study in this thesis indicate that use of computed tomography with calculations of bone mineral density can be a useful tool in bone tissue evaluation before implant placement. After 1 year of loading, changes in marginal bone level, compared to baseline, did not differ between implants that were stable and implants that were not stable at placement. The results of this thesis do not strengthen earlier recommendations that immediate and early loading is a treatment alternative that can be considered only in jaws with good bone quality. In conclusion, immediate loading with interim fixed prostheses in the edentulous maxilla is a viable treatment alternative. Splinting of implants seems to be important in immediate loading, especially when bone density is low.     

“All-on-four” concept and immediate loading for simultaneous rehabilitation of the atrophic maxilla and mandible with conventional and zygomatic implants

We report the simultaneous rehabilitation of an edentulous patient with a hybrid (zygomatic and conventional implants) all-on-four implant-supported prosthesis for the maxilla and a standard (conventional implants) all-on-four implant-supported prosthesis for the mandible. The transfer impression was made with a multifunctional guide and the upper and lower prostheses were placed 24 h postoperatively. Clinical and radiographic examinations showed no infection or bony resorption 2 years later. Simultaneous maxillary and mandibular rehabilitation with all-on-four immediate loading is a viable, fast and effective option for edentulous patients.     

Narrow-diameter implants versus regular-diameter implants for rehabilitation of the anterior region: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to evaluate studies comparing implant survival rates, marginal bone loss (MBL), and mechanical and biological complication rates between narrow-diameter implants (NDIs) and regular-diameter implants (RDIs) used for oral rehabilitation in the anterior region. The review was conducted according to the PRISMA checklist. Two independent reviewers performed a comprehensive search of the PubMed/MEDLINE, Embase, Scopus, and Cochrane Library databases for studies published until May 2020. A total of 843 implants (484 NDIs and 359 RDIs) were included. No significant difference in implant survival rate (risk difference (RD) 0.01, 95% confidence interval (CI) ?0.01 to 0.03; P = 0.34), MBL (standardised mean difference ?0.51 mm, 95% CI ?1.29 to 0.26 mm; P = 0.19), mechanical complications (RD 0.01, 95% CI ?0.02 to 0.04; P = 0.40), or biological complications (RD 0.01, 95% CI ?0.09 to 0.11; P = 0.85) was found between the implant groups. Within the limitations of this study, it is concluded that NDIs are an effective alternative to RDIs due to similar survival rates, MBL, and mechanical and biological complication rates. However, future studies are highly encouraged due to the small number of interventional studies on this topic.     

Peri-implant bone changes following tooth extraction, immediate placement and loading of implants in the edentulous maxilla

The aim of this study was to clinically and radiographically evaluate peri-implant bone level changes after rehabilitation of a fully edentulous maxilla by placement of six implants in either fresh extraction sites or healed edentulous ridges up till 18 months after implant placement. Twenty patients with a terminal dentition in the maxillae (11 men, 9 women) received a total of 120 OsseoSpeed implants; 118 implants could be loaded immediately of which 59 were placed in extraction sockets and 59 were placed in healed sites. Within 24 h after surgery, all patients received a chairside-assembled, fibre-reinforced temporary fixed prosthetic reconstruction in occlusion. Six months post-surgery, final screw-retained CoCr (15) or Ti (5) computer numerical control-milled and acrylic-veneered frameworks were placed directly at implant level without interposing abutments. Intraoral radiographs were taken 6 and 18 months after implant placement. Implant survival rate was 100%. Mean marginal bone level was located on average -0.35 mm below the reference point (standard deviation 0.29, range -1.20 to +0.02 mm) 18 months after loading. Whether implants were placed in healed bone sites or fresh extraction sockets did not significantly affect the bone level changes. Furthermore, the use of either CoCr or Ti at the implant level did not significantly affect marginal bone loss. Within the limits of this prospective clinical trial, results seem to indicate that immediate placement and occlusal loading of five to six implants in the edentulous maxilla can be carried out successfully. Whether or not those implants are placed in fresh extraction sockets does not seem to alter the outcome. The present data show a successful 1-year outcome of a treatment protocol involving tooth extraction immediately combined with implant placement and loading.     

Long-term clinical outcomes of immediate loading versus non-immediate loading in single-implant restorations: a systematic review and meta-analysis

Dental implant restoration is a predictable treatment option for replacing missing or damaged teeth. Conventional loading requires a prolonged treatment period and second surgical interventions. The aim of this study was to compare the clinical outcomes between immediate and non-immediate (early or conventional) loading in single-implant restorations. A literature search of the PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov databases was performed in January 2020. Only randomized clinical trials (RCTs) were included. The overall risk ratios (RRs), mean differences (MDs), and 95% confidence intervals (CIs) were used in the analyses. A total of 10 RCTs reporting on 423 patients were included. There was no significant difference in any of the outcomes of interest between the immediate and non-immediate loading cases: implant failure at the patient level (RR 1.29, 95% CI 0.35 to 4.78, P = 0.71), implant failure at the implant level (RR 1.19, 95% CI 0.40 to 3.51, P = 0.75), marginal bone loss (MD ?0.04, 95% CI ?0.16 to 0.08, P = 0.54). Subgroup analyses showed similar results. Immediate loading had predictable long-term clinical outcomes if the indicated patients were carefully selected. The influences of several technical factors need to be confirmed in additional clinical trials.     

Immediate loading of dental implants in the completely edentulous maxilla: a clinical report

PURPOSE: The purpose of this article was to determine whether clinical success can be achieved with immediate loading in the completely edentulous maxilla with endosseous screw-type implants. MATERIALS AND METHODS: The study sample consisted of 34 patients who were edentulous or about to lose all remaining maxillary teeth. The patients underwent an extensive presurgical and prosthetic workup to determine whether they qualified for the study. Sufficient osseous structure to place 6 to 8 implants with a minimum length of 8 mm was required. Provisional prostheses were fabricated either chairside on the day of implant placement or in a laboratory from an impression. The abutments and temporary restorations were placed 48 to 72 hours postsurgery. RESULTS: A total of 236 implants were placed in 34 patients. Sixteen implants were lost in 11 patients; thus the survival rate was 93%. All patients subsequently received definitive maxillary restorations. DISCUSSION: The major cause of implant failure appeared to be micromotion during healing. This was the result of either a non-passively fitting restoration or noncompliance (eg, eating chewing hard foods before the implants had integrated). CONCLUSIONS: This clinical report suggests that immediate loading of implant-supported restorations in the completely edentulous maxilla was a viable treatment alternative for this patient population.     

The immediate loading of dental implants

The aim of this article is to identify current opportunities for the immediate loading of endosseous dental implants. A biologic basis for the clinical parameters associated with success and failure of immediately loaded implants is presented, and select clinical situations where immediate loading is presently advocated will be illustrated. The wide-ranging applications of the immediate-loading concept for endosseous dental implants will be introduced; however, further experimental validation is necessary before incorporating all of these various expedited therapeutic approaches into practice.     

倾斜种植体在上颌后牙区骨量不足患者中的应用

目的:探讨倾斜种植体作为一种避免上颌窦植骨的方法,应用于上颌骨后牙区骨量不足患者种植修复的可靠性。方法:2005年1月—2007年12月间,21例患者共27个固定桥修复上颌后牙缺失,分别使用ITI和Br覽nemark 2种种植系统共植入78颗种植体,其中34颗种植体采用倾斜植入,44颗轴向植入。所有患者均为上颌后牙区骨量不足无法直接接受常规种植体植入。种植体植入后常规愈合3个月,除1颗种植体失败外,其余种植体均功能性负载支持固定义齿修复,修复方式为黏结固位和螺丝固位。每例患者均于负载后12、24和36个月接受临床和放射学随访检查。采用SPSS11.0软件包对数据进行统计学处理。结果:上颌有1颗轴向种植体在术后2个月时失败,倾斜种植体无失败。随访时间为36个月。上颌轴向种植体的累积存活率为97.72%,倾斜种植体的累积存活率为100%,修复成功率为100%。随访期间,种植体周围软组织保持稳定,平均探诊深度和附着水平无明显变化。结论:倾斜种植体作为一种上颌骨后牙区骨量不足患者的治疗方法是可靠的,能有效避免植骨手术,并节约治疗时间。     

Replacement of severely traumatized teeth with immediate implants and immediate loading: literature review and case reports

One of the options for management of severely traumatized dentitions is to provide immediate implant placement with immediate loading. Three representative cases out of 15 patients with 23 traumatized teeth treated to date in our clinic are presented. None had labial bone fractures. The teeth were replaced with NobelReplace Groovy implants (Nobel Biocare, Gothenburg, Sweden) in the fresh sockets immediately after extraction. They were placed toward the palatal areas in the sockets and 3 mm below the gingival margins. If there were gaps between implants and sockets wider than 1 mm, particulate deproteinized bovine bone was grafted in the gaps. Immediately after placement, the implants were loaded with provisional prostheses. The final restorations were installed 3–4 months later. The patients were reevaluated clinically and radiographically 1–3 years after the final restorations had been placed. In all 15 patients, excellent functional and esthetic results were achieved. No implants showed radiolucency, peri‐implant suppuration, or mobility. The patients were satisfied with the results. Immediate implant placement with immediate loading is an option that provides good treatment outcomes and allows good functional and esthetic results, as well as addressing the social/psychological aspects of dental trauma.     

The effectiveness of immediate, early, and conventional loading of dental implants: a Cochrane systematic review of randomized controlled clinical trials

PURPOSE: To test whether there is a difference in success rates between immediately, early, and conventionally loaded implants. MATERIALS AND METHODS: All randomized controlled clinical trials (RCTs) of root-form osseointegrated oral implants having a follow-up of 6 months to 1 year comparing the same osseointegrated root-form oral implants loaded immediately (within 1 week); early (between 1 week to 2 months); or conventionally (after 2 months) were eligible. An exhaustive search was conducted with no language restriction on January 15, 2007. Outcome measures were prosthesis failures, implant failures, and marginal bone levels measured on intraoral radiographs. Screening of eligible studies, quality assessment, and data extraction were conducted in duplicate. Authors were contacted for any missing information. Results were expressed as random effects models using weighted mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. The statistical unit of the analysis was the patient. RESULTS: Twenty RCTs were identified, and 11 trials including a total of 300 patients were included. Six trials compared immediate versus conventional loading, 3 early versus conventional loading, and 2 immediate versus early loading. None of the meta-analyses revealed any statistically significant differences. CONCLUSIONS: It is possible to successfully load dental implants immediately or early after their placement in selected patients, although not all clinicians may achieve optimal results. A high degree of primary implant stability (high value of insertion torque) seems to be 1 of the prerequisites for a successful immediate/early loading procedure. More well-designed RCTs are needed. Priority should be given to trials comparing immediately versus early loaded implants. These trials should be reported according to the CONSORT guidelines (www.consort-statement.org).     

Early loading of endosseous implants in the augmented maxilla: a 1-year prospective study

In 10 patients, 68 endosseous implants were inserted in the augmented edentulous maxilla using a one-stage implant placement technique. Three months before implant insertion, the width and height of the alveolar crest were augmented with autologous bone grafts from the iliac crest. In all cases, the resulting bone volume was sufficient for implant insertion. According to an early loading protocol, the implant-supported overdenture was fabricated 2 months after insertion of the implants. Evaluation was performed according to a standardised protocol immediately and 1 year after fabrication of the prosthetic construction. The protocol included assessment of both clinical (bleeding score, pocket depth, implant mobility) and radiographic (marginal bone level on standardised radiographs) parameters. Three implants in two patients in the upper jaw were lost (survival rate: 95.6%). The peri-implant tissues had a healthy appearance and bone loss was minimal. Overall, the patients were very satisfied with the prosthetic construction. From this preliminary study, it is concluded that in selected cases, early loading of implants may develop into a predictable treatment modality after augmentation of the maxilla.     

Immediate post-extraction implants subject to immediate loading: a meta-analytic study

Since Br?nemark first started developing its implant system, there has been a continuous and significant evolution in oral implantology through experimental and clinical research, and many of the concepts that were once considered valid have now become the subject of debate. The insertion of the implant immediately after extraction of the tooth to be substituted has now become the implant treatment of choice and is associated with preserving the bone structure and the gingival architecture, as well as with reducing the treatment time, which ultimately benefits the patient. Objective: To evaluate the success rate of the immediate post-extraction implants (IPI) subject to immediate loading. Study Design: A meta-analytic study was carried out on 659 immediate post-extraction implants obtained from a bibliographic review of 25 articles published within the last 9 years. Results: We obtained a sample of 322 patients who had been treated with a total of 659 implants placed immediately following extraction. The mean age of the patients was 51 years old. A total of 441 implants were inserted in the maxilla, 152 in the mandible and 64 were placed in an unspecified location. The survival rate ranged between 85% and 100%. Conclusions: Immediate post-extraction implant treatment is an implant alternative with a survival rate similar to that of the conventional technique for implant placement and enables preserving both the bone structure and gingival architecture, as well as providing immediate functional loading, thus improving the quality of the treatment as far as the patient is concerned.     

Short dental implants: a systematic review

Growing evidence has suggested the utility of short dental implants for oral reconstructive procedures in clinical situations of limited vertical bone height. The aim of this review was to systematically evaluate clinical studies of implants < 10 mm in length, to determine short implant-supported prosthesis success in the atrophic jaw. Implant survival, incidence of biological and biomechanical complications, and radiographic peri-implant marginal bone loss were evaluated. Screening of eligible studies, quality assessment, and data extraction were conducted by two reviewers independently. Meta-analyses were performed by the pooling of survival data by implant surface, surgical technique, implant location, type of edentulism, and prosthetic restoration. Two randomized controlled trials and 14 observational studies were selected and analyzed for data extraction. In total, 6193 short-implants were investigated from 3848 participants. The observational period was 3.2 ± 1.7 yrs (mean ± SD). The cumulative survival rate (CSR) was 99.1% (95%CI: 98.8-99.4). The biological success rate was 98.8% (95%CI: 97.8-99.8), and the biomechanical success rate was 99.9% (95%CI: 99.4-100.0). A higher CSR was reported for rough-surfaced implants. The provision of short implant-supported prostheses in patients with atrophic alveolar ridges appears to be a successful treatment option in the short term; however, more scientific evidence is needed for the long term.