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.     

Survival of dental implants placed in vascularised fibula free flaps after jaw reconstruction

Purpose

Ablative oncological surgery to treat head-and-neck cancer often triggers a requirement for jaw reconstruction. Modern surgical procedures using free microvascular flaps afford acceptable outcomes in terms of restoration of bony and soft tissue defects. A fibula free flap is often the preferred flap, as the bone length is considerable and a two-surgeon approach is possible. Dental implants play important roles in functional rehabilitation. Our aim was to evaluate the survival of dental implants placed in reconstructed areas after transfer of fibula tissue to the jaw.

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 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 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.     

Long‐term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo‐mandibular defects due to extreme atrophy

Purpose: The objectives of this study were to evaluate (a) the clinical outcome of revascularized fibula flaps used for the reconstruction of extremely atrophic jaws and (b) the survival rates of dental implants placed in the reconstructed areas. Materials and methods: Between 1999 and 2004, 12 patients presenting with extreme atrophy of the edentulous jaws were reconstructed with fibula free flaps. Five to 12 months after the reconstructive procedure, 75 titanium dental implants were placed in the reconstructed areas, while prosthetic rehabilitation was started 4–6 months afterward. The mean follow‐up of patients after the start of prosthetic loading was 77 months (range: 48–116). Results: An uneventful healing of the bone transplants occurred in all patients. One out of the 75 dental implants placed was not loaded due to prosthetic reasons. No dental implants failed to integrate before prosthetic loading, while three were removed during the follow‐up period. Despite the high survival rate of dental implants (95.8%), a relevant number of them presented relevant peri‐implant bone‐level loss, ranging from 1 to 7 mm for maxillary dental implants and from 1 to 4.5 mm for mandibular dental implants. Conclusion: Although no failures of the bone transplants occurred and a high long‐term survival rate of dental implants were observed, this study showed that fibula free flaps do not guarantee dimensional stability of peri‐implant bone, despite the immediate blood supply delivered by the vascular pedicle. The peri‐implant bone resorption was higher when compared with the one related to dental implants placed in native bone. To cite this article:
Chiapasco M, Romeo E, Coggiola A, Brusati R. Long‐term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo‐mandibular defects due to extreme atrophy.
Clin. Oral Impl. Res. 22 , 2011; 83–91.
doi: 10.1111/j.1600‐0501.2010.01999.x     

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.     

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 versus delayed loading of dental implants placed in fresh extraction sockets in the maxillary esthetic zone: a clinical comparative study

PURPOSE: The aim of this study was to report a clinical comparative assessment of crestal bone level change around single implants in fresh extraction sockets in the esthetic zone of the maxilla either immediately loaded or loaded after a delay. MATERIALS AND METHODS: Forty patients were included in a prospective, randomized study. All patients required 1 tooth extraction (ie, 1 tooth with a hopeless prognosis) and were randomized into either the test group or the control group. Implants were positioned immediately after tooth extraction and were loaded immediately in the test group (20 implants) and after 3 months in the control group (20 implants). The implant site was prepared, with at least 4 mm of sound apical bone below the implant apex, and the coronal margin of the implant was placed at the buccal level of the bone crest. All implants were 13 mm long; 30 implants had a diameter of 5 mm, and 10 had a diameter of 3.75 mm. Radiographic examinations were made at baseline, at 6 months, and at 24 months. To compare the mean values between test and control group, a paired t test was performed (considered statistically significant at P < .05). RESULTS: After a 24-month follow-up period, a cumulative survival rate of 100% was reported for all implants. The control group resulted in a mean mesial bone loss of 1.16 +/- 0.32 mm and a mean distal bone loss of 1.17 +/- 0.41 (mean bone loss, 1.16 +/- 0.51 mm). The test group resulted in a mesial bone loss of 0.93 +/- 0.51 mm and a distal bone loss of 1.1 +/- 0.27 mm (mean bone loss, 1.02 +/- 0.53 mm). No statistically significant difference between control and test groups (P > .05) was found. CONCLUSION: The success rate and radiographic results of immediate restorations of dental implants placed in fresh extraction sockets were comparable to those obtained in delayed loading group.     

Immediate versus early nonocclusal loading of dental implants placed with a flapless procedure in partially edentulous patients: preliminary results from a randomized controlled clinical trial

The aim of this randomized controlled clinical trial was to compare the efficacy of implants placed with a flapless procedure and restored immediately (test group) or early (6 weeks) (control group) in partially edentulous patients up to 1 year after loading. Both groups were nonocclusally loaded. Ten patients were included in each group. No patients dropped out and no failures were recorded. Two complications occurred in the early loading group, but both were resolved. It can be concluded that the use of a flapless technique for placing implants in conjunction with nonocclusal immediate loading in select patients can provide excellent clinical results. These preliminary findings should be confirmed by larger randomized clinical trials.     

Problems with dental implants that were placed on vertically distracted fibular free flaps after resection: A report of six cases

We report the clinical outcome of dental implants placed on vertically distracted fibular free flaps that were used to reconstruct maxillary and mandibular defects after resection. Distraction osteogenesis (DO) of fibular free flaps was used for six patients (5 men, 1 woman) a mean of 19 months (range 11–38) after 5 mandibular and 1 maxillary reconstructions. A mean of 5 months (range 2–11) after removal of the distractor, 35 implants were inserted and loaded with implant-supported fixed prostheses. The mean (range) follow-up period was 39 (17–81) months. The course of the DO and the clinical and radiographic outcomes of the implants were assessed.Of six vertically distracted fibular free flaps, there was one case of vector lingual tipping during the consolidation phase and a fracture of the basal fibular cortex that necessitated additional grafting with iliac bone to stabilise the distracted area. The mean (range) vertical bone gain was 14 (12–15) mm. Four of 35 implants (11%) failed during the follow-up period. The mean peri-implant bone resorption was 2.5 mm. Cumulative implant survival was 31/35 (89%) and survival after loading 31/33 (94%).Distraction osteogenesis of fibular free flaps caused a remarkable number of complications and pronounced resorption of bone around the implants, probably as a result of the formation of granulomatous tissue; a careful peri-implant follow-up and the maintenance of oral hygiene are essential.     

Immediate loading dental implants: overview and rationale

Br?nemark established the concept of osseointegrated dental implants as a predictable modality for treatment of edentulous patients. He defined osseointegration as bone-to-implant contact at the microscopic level. Osseointegration was a revolutionary concept in implant dentistry. While earlier pioneers never considered direct bone anchoring of the implant, and even established interposition of fibrous tissue between implant and bone as desirable to mimic periodontal ligament function, Br?nemark et al. demonstrated that direct bone apposition at the implant surface was not only possible, but long lasting.     

Immediate loading of dental implants placed in severely resorbed edentulous mandibles reconstructed with autogenous calvarial grafts

OBJECTIVE: The aim of this prospective study was to present the clinical outcome of immediately loaded dental implants placed in edentulous, severely atrophied mandibles, after reconstruction with autogenous multilayered calvarial grafts. MATERIALS AND METHODS: Six patients, two males and four females, aged 40-67 years (mean: 56 years) presenting with severely atrophied edentulous mandibles (Cawood and Howell class VI), were reconstructed with multilayered calvarial bone grafts placed in the intraforaminal area of the mandible. Five to 8 months afterwards, 23 dental implants were placed in the reconstructed areas (three to four implants per patient) and immediately loaded with implant-supported overdentures. Patients were followed with clinical and radiographic controls annually. RESULTS: Recovery after the reconstruction was uneventful in all patients. All 23 implants were osseointegrated 1-3 years after the start of immediate loading. The survival and success rates of implants were 100% and 95.7%, respectively. CONCLUSION: Results from this study showed that immediate loading of dental implants placed in severely atrophied edentulous mandibles reconstructed with calvarial bone grafts is a predictable procedure, which permits a successful dental rehabilitation with a shortening of treatment times.     

部分牙缺失的即刻修复

为保证种植体初期稳定性,形成良好的骨整合,通常认为需在种植体植入后3-6月再延期修复。然而近年来,越来越多文献报道了牙列缺损即刻修复的病例,且取得良好的临床效果。但是,对牙列缺损的即刻修复尚存一些争议。本研究回顾近年文献同时结合本课题组的研究结果对牙列缺损即刻修复进行评估,并提出相关研究进展。     

Immediate loading of mandibular dental implants in partially edentulous patients: a prospective randomized comparative study

While immediate loading in the edentulous mandible is a well-documented procedure, there are limited scientific data on immediate loading in the partially edentulous mandible. Two-year success rates of immediate loading and conventional delayed loading of dental implants in partially dentate mandibles were compared. Patients were randomized into three groups: group A (n = 40), immediate provisionalization with nonocclusal loading; group B (n = 40), immediate provisionalization with occlusal loading; and group C (n = 37), delayed loading with single-stage surgery. Baseline and 2-year measurements included implant stability quotient, insertion torque, and peri-implant bone crest radiography. Two hundred nine implants were immediately loaded in 80 patients. The 2-year success rates were 93.3% for group B and 100% for groups A and C. Immediate provisionalization provided success rates similar to those for delayed loading only when not loaded in occlusion.     

Immediate loading of dental implants in the edentulous mandible

BACKGROUND: The authors review the literature regarding immediate implant loading in the anterior edentulous mandible, demonstrate the technique they currently use, review preliminary results and present an illustrative case. MATERIALS AND METHODS: The authors conducted a literature search using PUBMED and Ovid databases. They considered for review 31 articles in English from 1969 to 2003 that pertained to immediate loading of the anterior mandible. The authors developed a technique to provide a bar-supported prosthesis on the day of surgery. They treated five patients and followed them up for at least six months. The preliminary results are presented. RESULTS: This literature review demonstrated that immediate loading of anterior mandibular implants is an acceptable method, with predictable results. This case series demonstrates the potential for delivering a final bar on the day of surgery, based on the current evidence and clinical application. CONCLUSIONS AND PRACTICE IMPLICATIONS: The method described provides patients with immediate prosthetic restorations and a decreased treatment time compared with that for the traditional two-stage implant approach.