Immediate versus conventional loading of palatal implants in humans: a first report of a multicenter RCT

This study aims to analyze the clinical performance of two loading concepts on second-generation palatal implants (Orthosystem, Straumann, Basel, Switzerland) in a prospective multicenter randomized controlled clinical trial. At the time of this interim analysis, 41 patients have been randomized on a 1:1 basis to one of two treatment groups. Group 1 underwent conventional loading of palatal implants after a healing period of 12 weeks (gold standard) while group 2 underwent immediate implant loading within 1 week after implant insertion. We report initial results at 6 months after functional loading. The primary outcome parameter was implant success (no implant mobility, no implant loss). The implants in both groups were initially stable at the time of insertion, and all were eligible for randomization. Twenty-two patients (group 1) were subjected to conventional implant loading after 12 weeks while 19 patients (group 2) received immediate functional loading within the first week after insertion. Direct (e.g. distal jet appliances) as well as indirect forms of anchorage (conventional or modified transpalatal arch) were used. The magnitude of orthodontic forces ranged between 1 and 4 N for the immediate loading group and between 1 and 5 N for the conventional loading group. One implant in group 1 was lost during the healing phase. One dropout was registered in group 2. Thirty-nine implants were functionally loaded for over 6 months now. These preliminary data provide first evidence of the fact that immediate loading of palatal implants yields equivalent success rates as conventional loading to 4 N after 6 months.     

Immediate vs. conventional loading of palatal implants in humans

Objectives: To analyze the clinical performance and bone-to-implant contact (BIC) rate of two loading concepts on successfully healed and explanted palatal implants in humans.
Methods: From 2000 to 2006, two independent groups of patients, requiring maximum anchorage, were treated. Group 1 ( n =36) was subjected to immediate functional loading within the first 24 h after insertion while group 2 ( n =40) received conventional implant loading after 12 weeks. The magnitude of orthodontic forces ranged between 1 and 3 N. After orthodontic treatment, the implants were removed with a trephine drill. Histological workup by the cutting and grinding technique was performed for nearly the last third of palatal implants. Outcome variables were clinical implant survival and histological BIC rates.
Results: The implants in both groups were initially stable at the time of insertion. However, 3/36 in group 1 and 1/40 in group 2 were lost. The remaining implants were clinically stable and no mobility was recognized. The median BIC rates were 76% (SD, 25) in group 1 ( n =10) and 84% (SD, 13) in group 2 ( n =12) ( P =0.262; Mann–Whitney U- test, not significant).
Conclusions: The data support the concept of immediate indirect loading on palatal implants with forces of up to 3 N. On histological evaluation, immediate loading yielded similar BIC rates as conventional loading.     

Immediate loading implants: a clinical report of 1301 implants

The purpose of this study is to suggest 4 immediate load of implants techniques that are alternative and/or complementary to the traditional submersion technique. These techniques meet the criteria for implant immobilization during the entire period of osteointegration, and are based on the principles of splinting and load sharing. One hundred fifty-three maxillary and 309 mandibular arches were treated with 1301 implants. Only implants that satisfied the primary retention were immediately loaded with a provisional crown with wings (94), provisional plastic prosthesis (478), provisional plastic prosthesis with metal frame (293), and intraoral welding (436). Facies morphology, type of occlusion, size and function of the tongue, bone density, number, and length of implants appeared to have an influence on the results. Success rates achieved over 21 years are 99.3% with the intraoral welding machine, 98.3% with the provisional plastic prosthesis with metal frame, 97.9% with metal wings, and 88.02% with provisional plastic prosthesis. This last percentage is reflective of the years 1974 to 1984 when only blade-forms and root-forms with unscrewable abutments were available and a provisional plastic prosthesis was the only immobilization technique known. Guidelines are proposed for a treatment plan indicating when and why immediate loading implants can be suggested.     

Immediate loading of single-tooth implants: immediate versus non-immediate implantation. A clinical report

The hypothesis of the present study was that immediate loading of implant-supported restorations replacing single missing teeth could be a successful procedure. The present study compared the clinical success of immediately loaded single-tooth implants placed in fresh extraction sites to that of immediately loaded single-tooth implants placed in healed sites. From the years 1997 to 1998, 26 patients, ranging in age from 18 to 70 years, presented for the placement of 28 immediately loaded implants intended to support single-tooth ceramometal restorations. Nineteen implants were placed into fresh extraction sites, and 9 implants were placed into healed sites. Temporary prefabricated acrylic resin crowns were prepared and adjusted. At the time of traditional second-stage surgery (3 to 6 months after implantation), the implants were restored with single-tooth ceramometal prostheses. The survival rates were 82.4% and 100% for immediate and non-immediate implants, respectively. Follow-up ranged from 6 to 24 months from the day of implant placement, with a mean of 13 months for the immediate implants and 16.4 months for the non-immediate implants. Radiographic marginal bone loss after 3 to 6 months did not extend beyond the abutment-implant junction. Within the limits of the present investigation, immediate loading of single-tooth implants placed in healed sites is a possible treatment alternative. Immediate loading of single-tooth implants placed in fresh extraction sites carried a risk of failure approximating 20% in this patient population.     

Immediate functional loading of implants in single tooth replacement: a prospective clinical multicenter study

Objectives: The aim of the present study was to evaluate the outcome of immediate functional loading of implants in single-tooth replacement using two different installation procedures.
Material and Methods: One hundred and fifty-one subjects, who required single-tooth rehabilitation in the area of 15–25 and 35–45, were enrolled in eight private clinics in Italy. The implant sites were randomly allocated to one of the following treatment groups. In the control group, in which a standard preparation procedure for implant placement and submerged healing of the implant was used, abutment connection and loading of the implants were performed 3 months after installation. In the test group 1, a standard preparation procedure for the implant placement and immediate functional loading of implant was carried out. In the test 2 group, however, a modified implant installation procedure (osteotome technique) was used followed by immediate functional loading of the implant. Clinical and radiographic examinations were performed at 3 and 12 months of follow-up at all sites.
Results: Three implants (5.5%) from the test 2 group (osteotome preparation) and one (2%) from the test 1 group (conventional drill preparation) failed to integrate and were removed one and three months after implant installation. The mean marginal bone loss assessed at 12 months was 0.31 mm (test 1), 0.25 mm (test 2) and 0.38 mm (control) (no statistically significant differences were found between the three treatment groups.)
Conclusion: It is suggested that immediate functional loading of implants that are placed with a conventional installation technique and with sufficient primary stability may be considered as a valid treatment alternative in a single-tooth replacement.     

Immediate loading of dental implants in the edentulous mandible: a preliminary case report from an international prospective multicenter study

The ability to predictably achieve long-term osseointegration in patients with compromised anatomical resources has been demonstrated numerous times in modern oral implantology. Recently, clinical attention has focused on new methods of reducing treatment time. One-stage surgical procedures and immediate loading of implants at the time of placement are two techniques that have demonstrated promising clinical results. A prospective clinical study of immediately splinting and loading a new, one-stage implant is currently in progress in the United States and France. An overview of the implant design and presentation of one case study from the University of Pittsburgh demonstrates how this promising technique is performed.     

Immediate loading of dental implants placed in distracted bone: a case report

A 40-year-old female patient presented for rehabilitation of an edentulous mandible with endosseous implants. Radiologic examination showed evidence of moderate atrophy in the intraforaminal area and an even more pronounced level of bone resorption in the posterior mandible. The patient desired a fixed rehabilitation with re-establishment of the posterior occlusal plane. From an esthetic standpoint, it was necessary to provide a restoration with crowns the same height as the original teeth while avoiding an unfavorable biomechanical situation. Vertical distraction of the complete mandible was performed using a Martin distractor according to the Hoffmeister technique. At the end of the period of activation and consolidation, the distractor was removed and 8 Frialit-2 Synchro-type implants were placed in predetermined sites and immediately loaded with a cemented transitional prosthesis. Ten months later the definitive restoration was delivered. The absence of any pathologic symptoms or negative radiologic findings 12 months after the surgery suggests a satisfactory result in the short term.     

Immediate implants with immediate loading vs. conventional loading: 1-year randomized clinical trial

Purpose: This 1‐year randomized clinical trial compared the bone regeneration and success rates between immediate and conventional loading of dental implants placed immediately after extraction in patients with a past history of periodontal disease. Methods: Sixty patients who chose an immediate implant treatment option to replace a hopeless tooth were included in this study. Patients: Patients were randomly assigned to receive immediate implants with either immediate loading (group A) or conventional loading after 3 months (group B). At baseline, both groups received a mucoperiosteal flap, extraction, implant placement, allograft bone, and a membrane. Group A received a provisional crown. In group B, a cover screw was placed and primary closure was achieved. The patients were evaluated at 3, 6, and 12 months postoperatively. Results: The 1‐year implant survival rate was 95% for the whole study group: 96.6% for group A, and 93.3% for group B. The bone level increased significantly in both groups (group A: 0.99 ± 0.22 mm; group B: 0.75 ± 0.17 mm), and the difference was not statistically significant (p > 0.5). At the 1‐year postoperative visit, the mucogingival junction (MGJ) was found to be displaced coronally in 65% of implant sites in group B compared with 15% sites in group A. Conclusions: Both the immediate and delayed loading of immediately placed implants showed similar outcome with regards to treatment success rates and stability of radiographic bone level. Submerging an immediately placed implant and primary soft tissue closure did not show significant outcome advantages over the transmucosal approach.     

Immediate placement and loading of dental implants: a human histologic case report

BACKGROUND: The possibility of immediately loading postextraction implants was proposed recently. However, histologic evidence of osteointegration in such cases is still lacking. In this case report, two implants placed into fresh extraction sites, one immediately loaded and the other one unloaded, were compared clinically and histologically. METHODS: Two teeth in need of extraction and localized in two symmetric quadrants of one patient were extracted, and dental implants were placed immediately into fresh extraction sites. One of them was connected with a healing abutment (control), whereas the other one was loaded immediately (test) with a resin crown in occlusion with the antagonist teeth. Clinical examinations were made, and radiographs were taken at follow-up visits. After 6 months, control and test implants were removed, together with the peri-implant bone, and a histomorphometric analysis was made. RESULTS: Both implants appeared radiographically osseointegrated and clinically stable at retrieval. Mineralized tissue was found at the implant interface. The percentage of bone-to-implant contact in the control and test implants was 58% +/- 4.0% and 52% +/- 3.2%, respectively. In the loaded implant, a more compact, mature, well-organized peri-implant bone was found with many areas of remodeling and some osteons, whereas the bone tissue surrounding the unloaded implant was constituted of only thin bone trabeculae. CONCLUSIONS: Immediate loading did not seem to impair osseointegration of an immediate postextraction implant compared to an unloaded postextraction one. Further studies with a larger number of samples are needed to confirm these preliminary results.     

Immediate loading of 4 implants. A case report

Despite the obvious benefits of two-stage implants, patients do experience discomfort as they have to continue wearing non-fixed total dentures whilst postoperative healing takes place. These patients would be more comfortable if a functional and esthetically pleasing solution could be arrived at in a shorter time. In an effort to achieve this, the scientific community has researched and fitted 'immediate load' implants. The current literature states that this procedure, when fitting 4 or more interforaminal implants, is both predictable and reliable. The procedure increases neither the number of implant failures nor the amount of bone lost. In the case reported, 4 implants were inserted and a bar constructed. The practicality of this procedure is seen in reduced time and costs. An initial total denture was used at the start, first as a surgery guide, then as an individual tray for impression, and eventually as final total denture. Fixing the initial total denture to the implant, considerably reduced the time taken in the whole implant procedure and provided the patient with a more comfortable, pleasing solution. The use of the bar prevented the denture from moving, guaranteed full support from the implants, and reduced or prevented the bone loss seen in patients where non-implant supported total dentures have been used. This procedure had the additional benefit of versatility - as it could have been used as an intermediate stage towards providing a more complex prosthesis, such as a Toronto prosthesis.     

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.     

全口即刻负重种植固定义齿2例

对2例全口多数牙缺失、残留少量重度牙周炎患牙的患者拔除全口余牙,即刻于上下颌分别植入10颗和8颗Straumann种植体,36颗种植体经共振频率分析,种植体稳定指数（ISQ）值大于60的34颗种植体即刻接入临时基台行复合树脂临时固定桥修复,3个月左右种植体形成骨整合后完成永久性修复。修复后追踪18～26个月,无1颗种植体失败,平均累积骨丧失为0.41 mm。     

Immediate occlusal loading of freestanding implants using cortical satellite implants: preliminary report of a prospective study

Freestanding implants with mandibular overdentures are used frequently after 3 months' healing time. Immediate full loading may be applied to this approach if sufficient primary stability is provided. The present study evaluates the success rate of two single-standing interforaminal implants stabilized with cortical satellite implants and loaded immediately with overdentures. Twenty patients (five male and 15 female; age, 45-87 years) received two single-standing titanium screw implants (Semados, Bego, Bremen, Germany). All implants were stabilized during healing time with cortical satellite implants (2.0-mm bone screws; Medartis, Basel, Switzerland) via individual connectors attached to the implant abutment subgingivally. Mandibular overdentures were incorporated immediately after surgery using ball attachments as retentive elements. The patients were under no restrictions concerning diet and loading. The satellite implants were removed after 3 months. All implants were osseointegrated after 10 months' mean observation time. The mean Periotest value was -4.9, and the mean marginal bone loss was 0.7 mm. No dropouts were observed, and 19 of 20 patients would recommend the treatment to a close friend. Preliminary follow-up data indicate that cortical stabilization of two anterior mandibular implants with satellite implants leads to osseointegration of the implants under immediate load conditions with an overdenture. This concept contributes to reduction of prosthetic treatment costs and permits immediate enhancement of masticatory function.     

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.     

Immediate versus delayed loading of dental implants in edentulous maxillae: a 36-month prospective study

Purpose: The aim of this study was to compare survival rates and radiographic outcomes of immediate and delayed implant loading in edentulous maxillae. Materials and Methods: Forty-nine patients in need of maxillary full-arch treatment were randomized into two groups: test group (n = 34) treated following the Columbus Bridge Protocol with 4 to 6 implants loaded within 24 hours and a control group (n = 15) treated following the ad modum Branemark protocol with 6 to 9 implants loaded a mean 8.75 months after surgery. Two hundred sixty implants (test: n = 163, control: n = 97) were placed, and subjects were treated with screw-retained full-arch prostheses. Bone levels were measured at baseline and at 1, 2, and 3 years and analyzed using repeated-measures analysis of variance. Results: All patients appeared at all scheduled recall visits. No differences in cumulative survival rates were found between groups at 36 months. Ten implants (6.1%) failed in the test group; four (4.1%) failed in the control group. At 36 months, no prosthetic failures were detected. Significantly less bone loss was found in the test group at all time intervals (P < .001). The average bone level from the implant-abutment connection was 1.3 mm in the test group and 1.9 mm in the control group at 12 months, 1.5 mm and 2.2 mm at 24 months, and 1.6 mm and 2.3 mm at 36 months, respectively. Conclusion: In the edentulous maxilla, the Columbus Bridge Protocol involving immediate loading of implants placed in both healed and fresh extraction sites exhibited equivalent implant survival and less marginal bone loss at 3 years compared to the conventional two-stage delayed loading protocol. Int J Prosthodont 2011;24:294-302.     

Immediate loading of dental implants in partially edentulous patients: A clinical report

Immediate loading of dental implants offers attractive advantages for patient and prosthodontist alike. Current data support immediate loading of splinted screw-shaped implants in the parasymphysis region. This report presents a case of a partially edentulous patient successfully restored with a fixed implant prosthesis following an immediate loading protocol.     

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 implant loading: a case report

The therapeutic goal of implant dentistry is not merely tooth replacement but total oral rehabilitation. Considering dental implants as a treatment option can provide patients with positive, long-term results. Implants have developed into a viable alternative to conventional prosthetic reconstruction of edentulous areas. They provide excellent support for fixed or fixed detachable appliances, which increases function compared with conventional complete dentures. Implant dentistry has gone through many phases over the years. Modern technology and design allows us to predictably place our dental implants in immediate extraction sites and often load the implants at the time of placement. Single tooth-by-tooth reconstruction provides easy access for the patient to floss and clean the areas compared with the relative difficulty in maintenance when crowns are splinted. This case study demonstrates full maxillary and partial mandibular reconstruction using dental implants. The implants were surgically placed immediately after extractions and loaded using a stable roundhouse composite temporary bridge. Following osseointegration, the implants were permanently restored with individual crowns.