Parallel screw cylinder implants: comparative analysis between immediate loading and two-stage healing of 1,005 dental implants with a 2-year follow up

Background Recently, several authors have focused on the possibility of an immediate functional loading of dental implants to minimize the delay between surgical and prosthetic phases. Purpose The aim of this study was a reevaluation of the XiVE® dental implant (Dentsply‐Friadent, Mannheim, Germany) with: (1) a longer follow‐up period; (2) a higher number of fixture; and (3) a proper statistical method. Materials and Methods In July 2001 and December 2002, 371 patients (180 males and 191 females; ages ranging from 17 to 83; mean age, 53 years) were consecutively enrolled in this study. In 371 patients, a total of 1005 XiVE dental implants were distributed as follows: 484 immediately loaded implants (test group) were inserted in 130 patients, whereas 521 unloaded implants were inserted in 241 patients (control group). Results The implant survival was 98.7 and 99.4% in immediate loading and control group, respectively. Univariate analysis showed no statistically significant difference between the two groups. Conclusion In a previous report, we showed that immediate loading offered a predictable and reliable procedure also for XiVE implants, at least in the short period. In this study, we confirmed the results of the previous study and added information regarding the survival rate and marginal bone level stability with a 2‐year follow up.     

Effect of implant loading protocols on failure and marginal bone loss with unsplinted two-implant-supported mandibular overdentures: systematic review and meta-analysis

The aim of this study was to compare implant failure and radiographic bone level changes with different loading protocols for unsplinted two-implant-supported mandibular overdentures. An electronic search of two databases (PubMed, Cochrane Library) was performed, without language restriction, to identify randomized controlled trials (RCTs) comparing immediate or early versus conventional dental implant loading protocols for unsplinted two-implant-supported mandibular overdentures. Data were extracted independently by two reviewers. The Cochrane tool was used to assess the quality of included studies. A meta-analysis was performed. Eight RCTs were identified, seven of which were included; one trial was excluded because related outcomes were not measured. Four of the seven studies were considered to have a high risk of bias and three an unclear risk. Meta-analysis revealed no difference between immediate versus conventional or early versus conventional implant loading protocols regarding implant failure (risk difference (RD) ?0.02, 95% confidence interval (CI) ?0.13 to 0.10; RD 0.09, 95% CI ?0.03 to 0.20) or marginal bone loss (mean difference (MD) 0.09, 95% CI ?0.10 to 0.28; MD ?0.05, 95% CI ?0.12 to 0.02) for implants supporting mandibular overdentures. These findings should be interpreted with great caution given the serious numerical limitations of the studies included.     

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.     

Marginal bone loss one year after implantation: a systematic review of different loading protocols

The aim of this study was to analyse the influence of different loading protocols on marginal bone loss (MBL). The outcomes of different implant loading protocols were assessed at 1 year after implantation, with focus on MBL; protocols included immediate, immediate non-occlusal, early, and conventional loading. The search strategy resulted in 889 studies. Twenty-two of these studies fulfilled the inclusion criteria. Among the included studies, the lowest MBL was for immediately loaded implants (0.05 ± 0.67 mm) and the highest for immediate non-occlusally loaded implants (1.37 ± 0.5 mm). The results of the meta-analysis showed an estimated mean MBL of 0.457 mm (95% confidence interval (CI) 0.133–0.781) for immediate loading, 0.390 mm (95% CI 0.240–0.540) for immediate non-occlusal loading, 0.488 mm (95% CI 0.289–0.687) for early loading (>2 days to <3 months), and 0.852 mm (95% CI 0.429–1.275) for conventional loading (>3 months) implant protocols. The lowest decrease in 1-year implant survival per millimetre increase in MBL was observed for immediate loading and the highest for conventional loading. Conventional loading showed a significantly higher MBL than the other three loading protocols. This systematic review and meta-analysis indicates that the immediate loading protocol is a reasonable alternative to the conventional loading protocol.     

Comparative analysis of immediate functional loading and immediate nonfunctional loading to traditional healing periods: a 5-year follow-up of 550 dental implants

Background: Clinical, radiographical, and histological findings have shown that immediately loaded implants show the presence of mineralized tissues at the interface.
Purpose: The aim of this study was to compare an immediate loading protocol with a two-staged one using an implant with a square thread design.
Materials and Methods: One hundred fifty-five consecutive patients (71 men, 84 women), aged between 18 and 78 years (mean: 54 years) participated in this study. A total of 550 implants (Maestro; BioHorizons, Birmingham, AL, USA) were inserted. In group A, 264 implants were inserted in 82 patients with immediate functional loading with occlusal contact if the patients were completely edentulous, or with immediate nonfunctional loading without occlusal contact if the patients were partially edentulous. In group B, 286 implants were inserted in 73 patients with a one-stage or two-stage surgical procedure. All patients were followed for at least 5 years.
Results: In the immediately loaded implants group, three implants failed, all in posterior mandibular sites, with an overall 98.8% 5-year survival rate. In the control group, no implant failed, with a 100% 5-year survival rate. No statistically significant differences were found in the survival rates of the implants in the two groups.
Discussion: A very high implant survival rate was also present in our series for the immediately loaded implants. All the three failed implants were retrieved from the same patient, who had poor oral hygiene, after a loading period of 5 years. These data can suggest that, from a clinical point of view, an abbreviated healing period is compatible with the development and maintenance over a longer time period (5 years) of mineralized tissues at the interface with dental implants.
Conclusion: We can then conclude that shorter healing periods can be highly satisfactory from a clinical point of view.     

348枚牙种植体即刻种植的临床疗效及体会

目的:探讨即刻种植义齿修复牙缺失的外科植入方法,观察其临床疗效,评价其相关影响因素。方法:192例患者在拔牙同时即刻植入种植体348枚,前牙160枚,前磨牙80枚,磨牙108枚,3-9个月后行永久性修复,定期进行复诊和随访,观察6-84个月。结果:348枚种植体中,13枚因各种原因脱落、拔除,其余种植体骨结合好,取得了良好的临床效果,累积存留率96.26%。结论:即刻种植义齿具有自身优点,手术可行,在控制好适应证的情况下,可以取得良好的临床效果。     

Immediate loading of dental implants

The purpose of this review is to explore the concept of immediate loading as it pertains to dental implants and the indications for clinical practice. The definition of immediate loading will be considered together with a review of the relevant literature in an attempt to provide evidence-based guidelines for successful implementation into practice.
A search of electronic databases including Medline, PubMed and the Cochrane Database of Systematic Reviews was undertaken using the terms ``immediate loading', ``dental implants', ``immediate function', ``early loading', ``oral implants', ``immediate restoration' and ``systematic review'. This was supplemented by handsearching in peer-reviewed journals and cross-referenced with the articles accessed. Emphasis was given to systematic reviews and controlled clinical trials.
A definition of immediate loading was suggested pertinent to the realities of logistics in clinical practice with respect to application and time frame. The literature was evaluated and shown to be limited with significant shortcomings. Guidelines and recommendations for clinical protocols were suggested and illustrated by examples of case types with a minimum of 1–3 years follow-up. A list of additional references for further reading was provided.
Within the limitations of this review, there is evidence to suggest that immediate loading protocols have demonstrated high implant survival rates and may be cautiously recommended for certain clinical situations. However, more high level evidence studies, preferably randomized controlled trials (RCTs), over a long time frame are required to show a clear benefit over more conventional loading protocols.     

Dental implants in patients with osteoporosis: a systematic review with meta-analysis

There is currently no consensus regarding the survival rate of osseointegrated implants in patients with osteoporosis. A systematic review with meta-analysis was performed to evaluate the survival rate of implants in such patients. The PubMed/MEDLINE, Web of Science, Cochrane Library, and SciELO databases were used to identify articles published up to September 2016. The systematic review was performed in accordance with PRISMA/PICO requirements and the risk of bias was assessed (Australian National Health and Medical Research Council scale). The relative risk (RR) of implant failure and mean marginal bone loss were analyzed within a 95% confidence interval (CI). Fifteen studies involving 8859 patients and 29,798 implants were included. The main outcome of the meta-analysis indicated that there was no difference in implant survival rate between patients with and without osteoporosis, either at the implant level (RR 1.39, 95% CI 0.93–2.08; P = 0.11) or at the patient level (RR 0.98, 95% CI 0.50–1.89; P = 0.94). However, the meta-analysis for the secondary outcome revealed a significant difference in marginal bone loss around implants between patients with and without osteoporosis (0.18 mm, 95% CI 0.05–0.30, P = 0.005). Data heterogeneity was low. An increase in peri-implant bone loss was observed in the osteoporosis group. Randomized and controlled clinical studies should be conducted to analyze possible biases.     

Clinical performance of one‐piece zirconia dental implants: A systematic review

The aim of the present review was to evaluate the clinical and radiographic performance of one‐piece zirconia implants (O‐PZI). This review followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta‐Analysis) guidelines that addressed the following focused question: What is the overall clinical and radiographic performance of O‐PZI? The MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register databases were searched. Six clinical studies were included. For studies evaluating O‐PZI compared with one‐piece titanium implants, zirconia implants showed higher crestal bone loss (CBL) in both the studies. However, one study demonstrated a high failure rate compared to titanium dental implants, while one study demonstrated comparable survival rates between zirconia and titanium dental implants. For studies evaluating O‐PZI for the restoration of single crown and fixed dental prostheses, O‐PZI showed comparable bone loss and survival rates for single crowns and fixed dental prostheses. Two studies were included that compared O‐PZI with two‐piece zirconia (T‐PZI). One study showed a higher CBL and low survival rate for O‐PZI compared to T‐PZI, whereas the other study demonstrated comparable CBL and survival rates between O‐PZI and T‐PZI. It is still debatable whether O‐PZI demonstrate better clinical performance when compared with titanium implants or two‐piece design.     

Clinical outcomes of immediate/early loading of dental implants. A literature review of recent controlled prospective clinical studies

Two previous reviews have evaluated the clinical outcomes of immediate/early loading of dental implants based on studies published until 2005. ^1,2 The aim of the present paper was to review controlled clinical studies on the subject published since 2005 including at least 10 patients in each group followed for at least one year in function. Six comparative studies were found and none of these showed any differences in survival rates or marginal bone loss after one to five years. Most authors used specified inclusion criteria to avoid known risk factors such as soft bone, short implants and bruxism. Data from one randomized study in the edentulous maxilla showed no differences between early and delayed loading in consecutive clinical routine cases including short implants and soft bone. Three additional studies comparing different surfaces or implant designs under immediate loading were reviewed. No differences between implants with a moderately rough or smooth surface topography were observed. The data add to the previous bulk of evidence that various designs of implants can be loaded shortly after their placement in both the mandible and the maxilla. However, one study reported on marginal bone loss around a novel one-piece implant design leading to implant failure which was not seen for control two-piece implants. ³     

Immediate functional loading of provisional implants in the reconstructed atrophic maxilla: preliminary results of a prospective study after 6 months of loading with a provisional bridge

Implant-prosthetic rehabilitation of atrophic maxillae remains a challenging problem. The aim of this paper is to describe a novel treatment for functional rehabilitation of the atrophic maxilla and to discuss preliminary results of this treatment protocol. A prospective pilot study was carried out in 10 patients who underwent bony reconstruction of atrophic maxillae under general anaesthesia, with autologous calvarial bone grafts and simultaneous placement of six provisional implants. The provisional implants were loaded with a provisional acrylic bridge 1 day after surgery. After 6 months, the provisional implants were removed and final implants were placed under local anaesthesia, again in an immediate loading concept with a provisional bridge, followed by a final bridge after another 6 months of healing. The bone grafts integrated well in all 10 patients without infectious complications. The prosthetic survival of the provisional bridge at the time of placing the implants was 100%. All final implants could be placed and immediately loaded with a second provisional bridge. Patient satisfaction was high due to limited postoperative inconvenience and immediate fixed prosthetic rehabilitation. The preliminary results of this pilot study demonstrate that this treatment protocol is a well tolerated treatment for patients with maxillary atrophy desiring dental rehabilitation.