Immediate provisional restoration of Osseotite implants: a clinical report of 18-month results

PURPOSE: The purpose of this study was to assess the survival rates and interproximal bone levels for Osseotite implants that were restored with fixed provisional crowns without occlusion immediately after implant placement. MATERIALS AND METHODS: Ninety-three implants were placed in 38 partially edentulous patients. All implants were immediately restored with prefabricated abutments and cement-retained provisional crowns without centric or eccentric occlusal contacts. The implants were restored with definitive restorations approximately 8 to 12 weeks after implant placement. All patients included in the study were followed for at least 18 months after implant placement (average 20.3 months). RESULTS: Seventy-seven of the 93 implants satisfied the inclusion criteria. Seventy-five implants became osseointegrated. The overall survival rate was 97.4%. Radiographic bone loss 18 months after implant placement (the mean of both interproximal surfaces) was 0.76 mm. The exact binomial confidence interval was 0.32% to 9.07%. For the exact binomial test with the null hypothesis proportion = .05, P was .3334 and was not statistically significant. DISCUSSION: Immediate nonocclusal loading of single-unit dental implants differs from immediate loading of multiple, splinted implants. Unsplinted, restored implants without occlusal loading may still be subject to lateral and occlusal loads secondary to the proximate location of the food bolus. Immediate restoration of dental implants significantly reduces treatment time and may be beneficial in reducing the morbidity associated with loss of teeth, contraction of the alveolus, and loss of interdental papillae associated with the traditional method of treatment following tooth loss. CONCLUSIONS: The results of this study suggest that immediate restoration of Osseotite implants can be accomplished with results that are similar to the results obtained with the traditional 1- or 2-stage surgical, unloaded healing protocols.     

Immediate loading of single-tooth restorations: one-year prospective results

Immediate loading of splinted implant restorations is a growing trend, but limited clinical documentation hampers evidence-based treatment planning for single-tooth applications. This study prospectively evaluated the clinical efficacy of placing implant-supported, single-tooth restorations into immediate, full-occlusal loading. Sixty consecutive patients (intent-to-treat group) with 1 missing tooth between 2 intact teeth were treated with a total of 69 implants. At placement, final impressions were made and implants were provisionalized with nonoccluding prostheses. Definitive prostheses were delivered 2 weeks later. A claim of noninferiority was made with a 95% confidence interval (Mann-Whitney U test) if the success rates between the experimental group and a 97% historical control was > 7%. Standardized radiographs taken at placement and bimonthly intervals were analyzed for crestal bone changes at a type I (alpha) error level of .05; significance levels were not adjusted for multiplicity (Fisher exact tests and Student t tests). Sixteen patients (18 implants) were withdrawn for protocol deviations. The resulting treated-per-protocol group consisted of 44 subjects with 51 implants. Cumulative implant success rates were 98.55% (n = 68/69) for the intent-to-treat group and 98.04% (n = 50/51) for the treated-per-protocol group. There were no significant adverse events or statistically significant differences between the experimental and historical control groups. At 12 months mean crestal bone loss was 1.05 mm, and ranged from 0.38 to 1.5 mm (77%) and 1.6 to 2.69 mm (23%). Immediate full-occlusal loading of single-tooth restorations was safely performed in selected subjects when good primary implant stability and an appropriate occlusal load were achieved.     

Immediate loading of single-tooth implants in the anterior maxilla. Preliminary results after one year

According to the standard protocol, a load-free healing period is one of the most emphasized requirements for implant integration. Recent studies have encouraged a progressive shortening of the healing period for single-tooth implants and immediate loading has been proposed for the aesthetic zone in the maxilla. The present study evaluated clinical outcomes of immediately loaded FRIALIT-2 Synchro implants 12 months after placement in the maxillary incisal region. In the course of our investigation, nine patients have been treated following an immediate loading protocol. The stepped-screw type implants were inserted with an increasing torque up to 45 Ncm, thus measuring the primary stability of the implants. All implants were immediately restored with unsplinted acrylic resin provisional crowns and the patients provided with occlusal splints. Regular controls were performed at monthly intervals, intraoral radiographs were taken directly after implant placement, 6 and 12 months post insertion. The survival rate, clinical stability (Periotest) and radiographic coronal bone defects (CBD) were evaluated at delivery of the definitive superstructures (CBD 6) and 6 months later (CBD 12). Twelve FRIALIT-2 Synchro stepped screws of 3.8, 4.5 and 5.5 mm diameter and 13 and 15 mm length were placed in the incisal maxillary region. The median Periotest value 6 months post insertion was -2 with a minimum of -5 and a maximum of +2. The mean coronal bone level changes (CBD) at 6 and 12 months were 0.45 and 0.75 mm. No implant failed up to 12 months after insertion, resulting in a 100% survival rate. The presented results showed promising data for immediately loaded single-tooth implants in the anterior maxilla. Periotest values were within the range published for submerged implants. The radiographic coronal bone resorption after 6 and 12 months was even less than evaluated for implants placed in a standard two-stage procedure. It is evident that successful immediate loading protocols require a careful and strict patient selection aimed at achieving the best primary stability and avoiding any excessive functional or non-functional loading. Additional research needs to be done to provide data in situations where problems of poor bone quality, multiple implants or augmentation procedures must be overcome.     

Restoration of partially edentulous patients using dental implants with a microtextured surface: a prospective comparison of delayed and immediate full occlusal loading

PURPOSE: The aim of this study was to determine the clinical effectiveness of placing dental implants with microtextured surfaces into full occlusal loading at the time of placement in partially edentulous patients. MATERIALS AND METHODS: Two demographically similar groups of 14 patients each were treated with a total of 92 Spline Twist Implants (Centerpulse Dental, Carlsbad, CA). Test implants were placed into immediate full occlusal loading, and control implants were restored using a conventional delayed loading procedure. Otherwise, both groups of patients received similar therapy from the same treatment team. Radiographs, periodontal indices, and Periotest values were recorded every 6 months during routine clinical follow-up appointments. The mean loading time for all prostheses was 24 months at the time of this report. RESULTS: No implants failed in the test group, and 1 implant failed before loading in the control group. Cumulative implant success was 98.9% for all implants placed (test group = 100%; control group = 92.9%). Periodontal measurements indicated no significant clinical differences between implants placed into immediate full occlusal loading and those loaded via a conventional delayed protocol. DISCUSSION: Immediate full occlusal loading of partial prostheses supported by microtextured implants in partially edentulous patients demonstrated excellent clinical results, with no adverse periodontal effects after 24 months of function. Additional follow-up will provide invaluable information on the long-term effects of this technique. CONCLUSION: Immediate full occlusal loading of partial prostheses supported by microtextured implants can be successfully achieved for 24 months in highly motivated patients with excellent oral hygiene.     

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.     

Immediate loading of implants in the edentulous maxilla: use of an interim fixed prosthesis followed by a permanent fixed prosthesis: a 32-month prospective radiological and clinical study

Purpose: The aim of this study was to prospectively evaluate the survival rate of splinted and immediately loaded Straumann sandblasted, large-grit, acid-etched, solid-screw dental implants in the edentulous maxilla after 32 months of loading.
Materials and Methods: Twenty-eight patients (mean age 63 years) with edentulous maxillae received 168 implants (six each) and an implant-supported fixed interim prosthesis within 24 hours after surgery. After a mean healing time of 15 weeks, the patients received permanent screw-retained prostheses. Clinical and radiological examinations were made at implant placement and after 8, 20, and 32 months of loading. All permanent prostheses were removed at the 32-month follow-up; implant stability was checked with a torque device, and the implant stability quotient was determined with resonance frequency analysis.
Results: Mean marginal bone loss from baseline to 8 months after loading was 1.6 mm (SD 1.16; p  = .094), from 8 to 20 months 0.41 mm (SD 0.63; p  = .094), and from 20 to 32 months 0.08 mm (SD 0.49; p  = .039). The 32-month cumulative survival rate was 98.2%.
Conclusions: The 32-month survival of solid-screw implants – immediately loaded within 24 hours after placement – was similar to survival rates reported for solid-screw implants with conventional loading. Immediate loading and splinting of implants in the edentulous maxilla is a viable treatment alternative.     

Immediate function with fixed implant-supported maxillary dentures: a 12-month pilot study

STATEMENT OF PROBLEM: Immediate occlusal loading of dental implants in the edentulous mandible has proven to be an effective, reliable, and predictable procedure. There is little long-term data available on similar treatments in the edentulous maxilla. PURPOSE: The purpose of this study was to evaluate the 12-month implant survival after immediate loading of 4 to 6 implants with fixed screw-retained prostheses in edentulous maxillae. MATERIAL AND METHODS: Twenty-one patients, edentulous or with remaining teeth to be extracted in the maxilla, received 4 to 6 implants (n=111). The patients were restored with screw-retained fixed provisional prostheses supported by palladium-alloy frameworks within 24 hours after surgery. Insertion torques for implants were at least 40 Ncm. Implants, grouped as tapered or cylindrical screws, were placed in healed bone or extraction sockets. Implants were also classified as either vertical or off-angle. Definitive prostheses were placed after a mean healing time of 18 weeks. Radiographic examinations were made at the time of placement of provisional prostheses and 12 months later. Between-groups bone resorption was compared using 2-way ANOVA (alpha=.05). RESULTS: The mean follow-up time for all of the patients was 20 months (range, 13 to 28 months). The cumulative implant survival rate at the 12-month follow-up visits (after surgery) was 92.8%; the prostheses survival rate was 100%. No significant differences were found between the survival of tapered or cylindrical screw-type implants placed in postextraction sockets versus those in healed edentulous sites or between vertical and off-angle placed implants. Eight implants failed during the first 3 months, 5 of which were the most distal implants. The mean reduction in marginal bone height over the 12-month observation period was 0.84 mm (CI 95%; 0.68-0.99 mm). CONCLUSIONS: In this study with 12-month follow-up, 4 to 6 implants were sufficient to successfully support fixed implant screw-retained prostheses in the edentulous maxillae of 21 patients.     

A retrospective analysis of osseotite NT implants in clinical practice: 1-year follow-up

This article reports the preliminary results from a clinical study involving the use of implants with a natural taper design in edentulous and partially edentulous patients. Implants were followed for at least 12 months after occlusal loading. Three hundred nine implants were placed by two periodontists (176 maxillary, 133 mandibular; 198 anterior, 111 posterior). Digital radiographs were taken immediately after implant placement and 1 year after occlusal loading. Computerized measurements were made, with distances calculated between the implant restorative platforms and the greatest heights of interproximal bone on both interproximal surfaces at the time of implant placement and 12 months postplacement. At the 12-month recall appointments, it was noted that 8 of the 309 implants had failed. Osseotite NT implants can be used in the treatment of edentulous and partially edentulous patients using two-stage, single-stage, and immediate occlusal loading protocols with survival rates equivalent to those seen for cylindrically shaped implants.     

Immediate Occlusal Loading of NanoTite™ Tapered Implants: A Prospective 1‐Year Clinical and Radiographic Study

Background: During the last decade, high success rates have been reported for implants placed with immediate loading procedures, especially when bone quality and quantity provide good implant stability. In many of these studies, straight‐walled implants with moderately rough surfaces were employed. Tapered implants are becoming increasingly more popular due to standardized drilling protocols and reports of high initial primary stability. Purpose: The aim of the present prospective, single center clinical study was to evaluate surface topographical analysis and the clinical and radiographic outcomes of the NanoTite? (BIOMET 3i, Palm Beach Gardens, FL, USA) Tapered Implant when used for immediate loading of fixed prostheses and single‐tooth restorations. Materials and Methods: Forty‐two patients who needed implant treatment and met admission criteria agreed to participate in the study and were consecutively enrolled. Surgical implant placement requirements consisted of a final torque of a least 30 Ncm prior to final seating and an implant stability quotient above 55. A total of 139 NanoTite Tapered implants (112 maxillary and 27 mandibular) were placed by one investigator, and the majority of these implants (n = 77/55%) were placed in posterior regions, and in soft bone (n = 90/65%). A total of 57 prosthetic constructions were evaluated consisting of 20 single‐tooth restorations, 30 fixed partial dentures, and 7 complete, fixed maxillary restorations. Radiographs were taken at baseline and at 12 months of follow‐up. Results: Of the 139 study implants, one implant failure was declared. The overall cumulative survival rate at 1 year is 99.4%. Mean marginal bone resorption is 1.01 mm (SD 0.85) during the first year of function. Conclusion: Although limited to the short follow‐up, immediate loading of NanoTite Tapered implants seems to be a viable option in implant rehabilitation, when insertion torque of at least 30 Ncm is achieved. Further studies are needed to authenticate the finding of this study.     

A 2-year clinical report of patients treated with two loading protocols for mandibular overdentures: early versus conventional loading

BACKGROUND: The original Br?nemark protocol for dental implant treatment was based on submerged healing prior to loading. In recent years, immediate/early functional loading has been reported to be possible with high success for various indications including two splinted mandibular implants supporting an overdenture. However, there are a limited number of studies regarding the early loading protocol for two unsplinted mandibular implants supporting an overdenture. METHODS: A total of 26 edentulous patients were treated with two unsplinted dental implants supporting mandibular overdentures. All implants were placed in the canine regions of each mandible according to the one-stage surgery. For the test group, overdentures were connected 1 week after surgery, and for the control group, overdentures were connected 3 months after surgery. Peri-implant parameters were recorded 1, 6, 12, 18, and 24 months after surgery. Marginal bone levels were evaluated at implant placement and after 6, 12, 18, and 24 months. Clinical stability measurements were performed at surgery, and after 3, 6, 12, 18, and 24 months. RESULTS: No implant from either group was lost during 2 years. Clinical peri-implant parameters, clinical implant stability measurements, and marginal bone resorptions showed no statistically significant differences between the two groups during 24 months. CONCLUSION: The results of this clinical trial suggest that the early loading approach of two dental implants supporting a mandibular overdenture does not jeopardize peri-implant soft tissue health, marginal bone resorption, and implant stability.     

Immediate Loading of Two Implants with a Mandibular Implant‐Retained Overdenture: A New Treatment Protocol

Purpose: The aim of this study was to present the clinical outcomes of the immediate loading of two bar‐splinted implants retaining a mandibular overdenture. Materials and Methods: In a clinical trial, 124 edentulous patients were treated according to a new treatment concept, which involves the immediate loading of two bar‐splinted SLActive implants with an implant‐retained mandibular overdenture. The new conventional mandibular denture is used as a template for implant positioning and as an impression tray, and for mounting the retention clip by the dental laboratory. At the same day the implants are placed, the conventional denture is converted into an implant‐retained overdenture. During the healing and evaluation period, resonance frequency analysis (RFA) was undertaken to assess the effect of loading on implant stability and survival. Results: The survival rate of the implants was 98.8% during the evaluation period (12–40 months). Only 3 of the 248 implants were lost. During the healing (osseointegration) phase, the implant‐stability quotient increased significantly (p = .0001). During the evaluation period, four patients (3%) needed a relining of their mandibular overdenture, whereas 13 patients (11%) needed relining of the maxillary denture. Conclusions: Two interconnected implants can be successfully loaded by a mandibular overdenture at the same day of implant placement with a high survival rate of the implants. Only a few patients needed additional relining of the overdenture. Repeated RFA measurements can be useful in gauging implant stability and survival.     

A clinical report on the 18-month cumulative survival rates of implants and implant prostheses with an internal connection implant system

Titanium implants have been successful in both dentulous and edentulous patients. The original Br?nemark titanium implants were introduced with external hex connections between implants and abutments. Successes and failures/complications with both the biology and mechanics of this connection system have been reported. In an attempt to improve the predictability and success of implant/abutment connections, internal connections between implants and abutments were developed significantly differently from external implant/abutment connections in terms of size, surface area, and geometry. Forty-five consecutive partially edentulous patients were treated with 83 implants (Osseotite Certaina). The implants were allowed to heal for at least 8 weeks without occlusal loading. All were restored with single, nonsplinted restorations. The implants were loaded with fully functional occlusions for at least 1 year. Recall appointments were scheduled at 1, 6, 12, 18, 24, and 36 months after implant placement. Eighty-two of the 83 implants were clinically stable and considered to be osseointegrated 18 months after occlusal loading for a cumulative survival rate (CSR) (implants) of 100%. All of the abutment screws and restorations were non-mobile 18 months after occlusal loading for a CSR (prostheses) of 100%. This internal implant/abutment connection was clinically successful and should benefit restorative dentists involved in implant dentistry by decreasing the number of maintenance visits and problems associated with dental implant treatment.     

A resonance frequency analysis assessment of maxillary and mandibular immediately loaded implants

PURPOSE: This study evaluated the stability of implants in 51 patients following a clinical protocol of immediate functional loading. The stability during the first 3 months following implant placement was assessed according to bone type, implant location, and patient gender. MATERIALS AND METHODS: Twenty-two male and 29 female patients were treated with 344 Br?nemark System implants placed in edentulous bone or extraction sites and put into functional loading using the Teeth in a Day protocol. Each implant was tested for primary stability with resonance frequency analysis (RFA) at the time of implant placement, and RFA was performed at examinations 30, 60, and 90 days following surgery. RESULTS: The analysis was based on the 276 implants that were successfully measured using RFA at all postoperative intervals. The clinical implant survival rate was 98.5% for the total population. RFA showed a decrease in bone-implant stability in the first month after implant placement from 70.35 +/- 0.5 to 66.38 +/- 0.50, followed by increases in stability in the second and third months (68.01 +/- 0.50 and 68.82 +/- 0.49, respectively), suggesting a process of adaptive bone remodeling around the implant. In general, lower initial stabilities were seen in softer bone types, in the posterior portions of the jaw compared to anterior areas, and in the female population. DISCUSSION AND CONCLUSION: The results of this study suggest an immediate loading protocol should have an undisturbed period of healing for the first 2 months following implant placement. The determination of "predictor" stability levels for different clinical conditions were based on multiple splinted implants, allowing a larger surface area to withstand the distribution of the load. The most significant "predictor" values from a surgical and prosthodontic perspective are those determined in soft bone, in reduced bone, or in areas where lever arms are created as a result of long spans between the implants.     

Immediate nonocclusal versus early loading of dental implants in partially edentulous patients: 1-year results from a multicenter, randomized controlled clinical trial

PURPOSE: To compare the efficacy of immediate nonocclusal loading (test group) versus early loading (control group) in partially edentulous patients. MATERIALS AND METHODS: Fifty-two patients in 5 Italian private practices were randomized to 1 of the treatments: 25 to the immediately loaded group and 27 to the early loaded group. To be immediately loaded, single implants had to be inserted with a torque of > 30 Ncm, and splinted implants had to be inserted with a torque of > 20 Ncm. Implants in the immediately loaded group were provided with full acrylic resin nonoccluding temporary restorations within 48 hours after placement. After 2 months, full occluding provisional restorations were provided. Implants in the early loading group were not submerged and were loaded after 2 months. At 8 months, provisional restorations were replaced with definitive metal-ceramic prostheses. Outcome measures were prosthesis and implant failures as well as biologic and prosthetic complications recorded by nonblinded assessors. The Fisher exact test was used to compare the proportion of implant failures. RESULTS: Fifty-two implants were placed in the immediately loaded group and 52 in the early loaded group. No dropouts or complications occurred up to 14 months postinsertion. One single implant failed in the immediately loaded group 2 months after placement. There was no statistically difference for the tested outcome measures between the 2 procedures (P > .99). CONCLUSIONS: The results of this randomized controlled clinical trial with 25 patients rehabilitated with immediately restored nonocclusally loaded implant-supported prostheses compared to 27 patients restored 2 months following placement suggest that there are no major clinical differences in implant survival between these 2 protocols. No biologic or prosthetic complications occurred.     

Immediate loading with fixed full-arch prostheses in the maxilla: Review of the literature

Objectives: To critically review the evidence-based literature on immediate loading of implants with fixed full-arch prostheses in the maxilla to determine 1) currently recommended performance criteria and 2) the outcomes that can be expected with this procedure. Study Desing: Studies from 2001 to 2011 on immediate loading with fixed full-arch maxillary prostheses were reviewed. Clinical series with at least 5 patients and 12 months of follow-up were included. Case reports, studies with missing data and repeatedly published studies were excluded. In each study the following was assessed: type of study, implant type, number of patients, number of implants, number of implants per patient, use of post-extraction implants, minimum implant length and diameter, type of prosthesis, time until loading, implant survival rate, prosthesis survival rate, marginal bone loss, complications andmean follow-up time. Criteria for patient selection, implant primary stability and bone regeneration were also studied. Results: Thirteen studies were included, reporting a total of 2484 immediately loaded implants in 365 patients. Currently accepted performance criteria regarding patient and implant selection, and surgical and prosthetic procedures were deduced from the reviewed articles. Implant survival rates went from 87.5% to 100%, prosthesis survival rates from 93.8% to 100% and radiographic marginal bone loss from 0.8 mm to 1.6 mm.No intraoperative complications and only minor prosthetic complications were reported. Conclusions: The literature on immediate loading with fixed full-arch prostheses in the maxilla shows that a successful outcome can be expected if adequate criteria are used to evaluate the patient, choose the implant and perform the surgical and prosthetic treatment. Lack of homogeneity within studies limits the relevance of the conclusions that can be drawn, and more controlled randomized studies are necessary to enable comparison between the immediate and the conventional loading procedures. Key words:Immediate loading, full-arch, dental implants, loading protocols.     

临时种植体即刻负载在半颌即刻种植中的应用

目的：评价临时种植体即刻负载在半颌即刻种植中的应用效果。方法：20例半颌即刻种植患者行136枚即刻种植体植入,采用95枚临时种植体即刻负载恢复患者牙列。3-6月后行固定修复。结果：即刻负载临时种植体和即刻种植体成功率达100%。结论：临时种植体即刻负载半颌即刻种植是很好的临床方法。     

Prostheses Removal for Suture Removal after Immediate Load: Success of Implants

Purpose: The aim of this cohort study was to evaluate the success of implants after immediate loading in cases when the prostheses were removed for suture removal on the tenth day following implant placement. We describe a technique for fabricating effective definitive prostheses passively fitted to facilitate immediate load in edentulous patients. Materials and Methods: Seventy‐one patients with resin‐metal prostheses installed within less than 48 hours after implant placement were recalled. Patients for whom various amounts of time had elapsed since implant placement returned for follow‐up. Time elapsed ranged from 6 months to 7 years. Stability of the implants was tested after prosthesis removal by horizontal and vertical percussion tests. Implant success was determined as the number of functional implants displaying no mobility. Results: Follow‐up revealed that all implants from each period evaluated were stable, with no mobility (100% of implants success), except for the 1‐year time point (99.5%) and the 2‐year time point (98.9%). No signs of inflammation and/or bleeding were observed. Conclusion: Prosthesis removal for suture removal on the tenth day after implant placement represents a reliable and predictable procedure that did not jeopardize implant stability during bone remodeling.     

Clinical and radiographic evaluation of implant-retained mandibular overdentures with immediate loading

PURPOSE: The aim of this study was to evaluate and compare immediate-loaded implant-retained mandibular overdentures and delayed-loaded implant-retained mandibular overdentures. MATERIALS: Ten completely edentulous male patients received 40 dental implants. Patients were randomly divided into 2 equal groups, 5 patients each. Patients of both groups received conventional maxillary complete denture and had stage 1 surgery for placing 4 dental implant fixtures, 2 on each side anterior to the mental foramina. Group A: One-stage surgical procedure and immediate loading. Patients in this group received mandibular bar-retained overdenture supported by 4 endosseous implants loaded immediately after implant placement. Group B: The original 2-stage concept and delayed loading. Patients in this group received mandibular bar-retained overdenture supported by 4 endosseous implants that remained submerged for a period of 4 months before loading. The patients were evaluated clinically and radiographically immediately after overdenture delivery and after 6 months, 12 months, 18 months, and 24 months. RESULTS: The results of clinical evaluation showed no statistical significant difference between the 2 groups regarding the effect of treatment. The radiographic assessment showed no statistical significant difference in mesial and distal alveolar bone loss at the different intervals of the follow-up period, except at the 12-month period, where immediately loaded implants showed a decrease in the amount of alveolar bone loss mesially and distally compared to delayed loaded implants. CONCLUSIONS: The results suggest that immediate-loaded implants provide promising results compared to delayed-loaded implants and can be a possible alternative procedure in implant dentistry.     

Immediate occlusal loading of Osseotite implants in the lower edentulous jaw. A multicenter prospective study

OBJECTIVE: This paper reports the results of a prospective multicenter clinical study on immediately fully occlusally loaded full-arch screw-retained prostheses with distal extensions (hybrid prostheses) supported by Osseotite implants inserted in edentulous lower jaws. METHOD AND MATERIAL: Sixty-two patients were enrolled in four clinical centers. Three hundred and twenty-five Osseotite implants were inserted and occlusally loaded according to an immediate loading protocol. The temporary prosthesis was delivered 4 h from surgery. The final prosthesis was delivered after 6 months. Marginal bone loss was monitored from periapical radiographs using a computerized technique. RESULTS: Two implants failed to integrate within 2 months of occlusal loading. A cumulative implant success rate of 99.4% was achieved for a period of 12-60 months postplacement (mean 28.6+/-14.1 (SD) months). Crestal bone loss around the immediately loaded implants was similar to that reported for standard delayed loading protocols. CONCLUSION: The results of this study suggest that the rehabilitation of the edentulous mandible by an immediate occlusally loaded hybrid prosthesis supported by five to six Osseotite implants represents a viable alternative treatment to classic delayed loading protocols.     

Immediate loading with fixed screw-retained provisional restorations in edentulous jaws: the pickup technique

PURPOSE: This article describes (a) an immediate loading technique in the treatment of edentulous arches with screw-retained provisional restorations and (b) the effort to determine whether the described technique is compatible with the predictable achievement of osseointegration. MATERIALS AND METHODS: Eight patients with either 1 or 2 edentulous arches were treated. A diagnostic tooth arrangement was carried out for each patient and was then duplicated twice to fabricate a provisional template and a surgical guide. Six to 10 solid-screw ITI implants were placed around the dental arch to reach the first molar regions. On the same day, all patients received splinted metal-free screw-retained provisional restorations according to the pickup technique. The provisional prostheses were retrieved every 2 weeks during the healing phase. RESULTS: Seventy-eight implants were placed in 11 edentulous arches. Two implants were not immediately loaded because of inadequate primary stability. In an 8- to 20-month follow-up period (mean 14 months), two 8-mm implants were lost after 5 weeks of functional loading, resulting in an overall survival rate of 97.4%. All implants were assessed by resonance frequency analysis. After 4 months of functional loading, the mean implant stability quotient was 60+/-4.1 units (range 51 to 72 ISQ units) for maxillary implants and 65+/-6.5 units (range 47 to 74 ISQ units) for mandibular implants. DISCUSSION AND CONCLUSION: The immediate loading of implants placed in edentulous arches with screw-retained 1-piece (cross-arch) provisional restorations does not appear to jeopardize the achievement of osseointegration. Neither the metal-free design of the provisional prostheses nor the removal of the provisional prostheses during the healing phase adversely affected osseointegration. The pickup technique for immediate provisionalization represents a reproducible treatment option.