Immediate loading of 190 endosseous dental implants: a prospective observational study of 40 patient treatments with up to 2-year data

PURPOSE: The present study was undertaken to determine the feasibility of using primary stability as a predictor of implant success in patients whose implants were immediately loaded. MATERIALS AND METHODS: The study included 40 patients, in whom a total of 190 implants were placed, 102 in maxillary sites and 88 in mandibular sites. All were loaded within 72 hours of placement. Sixteen patients were completely edentulous in the mandible and/or the maxilla. The remaining 24, who were partially edentulous, received fixed partial dentures or single-implant restorations. All of the definitive implant restorations were screw retained. The criterion for loading was clinical judgment of primary stability, verified by a "screw test." Impressions were made after implant placement to facilitate the fabrication of a laboratory-made heat-processed provisional restoration from acrylic resin. Following a 4-month period for osseointegration and soft tissue healing, definitive fixed prostheses were fabricated. RESULTS: There were no surgical complications. After 1 to 2 years, all 190 implants had survived and were considered 100% successful, as determined by independent testing of mobility and radiographic evidence of osseointegration. In 4 patients, fracture of the provisional restoration occurred during the healing period. DISCUSSION: Clinical research has shown that immediate loading is a viable treatment modality. The favorable success rate reported in this study for rough-surfaced implants suggests that adherence to a protocol, an important parameter of which is primary stability above 32 Ncm, can lead to osseointegration. CONCLUSION: The results of this limited investigation suggest that patients who are partially or completely edentulous may be immediately restored with implants and fixed provisional restorations, provided that the dental implants are adequately stable immediately after their surgical placement. This alternative therapeutic approach did not appear to affect the up-to-2-year survival of the implants in this patient population.     

Immediate functional loading of immediate implants in edentulous arches: two-year results.

The purpose of this study was to evaluate the clinical success of immediate functional loading of immediate implants in edentulous arches. Five maxillary and five mandibular jaws were treated, and a total of 91 implants were placed; 66 of these implants were placed immediately after tooth extraction, and 25 were placed in healed sites. No bone substitutes or barrier membranes were used. Within 24 hours, fixed temporary restorations were inserted in all cases. During the entire 6-month healing time, all fixed temporary restorations were in normal function, after which the final fixed implant-supported restorations were inserted. After 24 months, the overall success rate of the implants was 92.31% (87.50% for the maxillary implants and 97.26% for the mandibular implants). The bone level measured mesially and distally was in 93.40% of all cases between the implant shoulder and the first thread. The present study shows that the immediate functional loading of immediate implants without the use of any bone substitutes or barrier membranes for fixed complete-arch reconstructions can be successful over a 2-year period.     

Prognosis of immediately loaded implants and their restorations: a systematic literature review

Immediate loading of oral implants has become popular because of the increasing demands of a shortened treatment time. This literature review evaluates the prognosis of immediately loaded implants and their restorations with immediate or delayed implant placement. Special attention was given to the impact of type of jaw, bone quality, implant length, time of implant placement and type of restoration. An electronic (PubMed) and a manual search in relevant journals were conducted until February 2012. Only publications in English, in peer-reviewed journals, were considered. Nine studies met the inclusion criteria: five studies dealt with fixed restorations, two studies with removable rehabilitation of edentulous jaws and two studies dealt with partially edentulous patients. Implant survival rates ranged from 95·8% to 100%, implant success rates in the treatment for the mandible from 79% to 100% and restoration survival rates for both jaws from 96·4% to 100%. Within the limits of this review, appropriate patient selection, primary implant stability, splinting of implants and the expertise of surgeons seem to be important for the prognosis of immediately loaded implants and their restorations. Good bone quality and use of long implants appear to play a role. However, careful interpretation is required because conclusions are based on articles with low level of evidence. While immediate loading of oral implants in the mandible shows encouraging and predictable results, further multicenter randomised controlled clinical trials with sufficient statistical power are needed to examine (i) the outcome of immediately loaded implants in the maxilla and (ii) the outcome of immediate loading of immediately placed implants.     

Syncrystallization: a technique for temporization of immediately loaded implants with metal-reinforced acrylic resin restorations

Background Rigid temporization has been recognized to have a significant impact on the peri‐implant tissue response in immediate implant loading since it reduces the mechanical stress exerted on each implant. Purpose A successful protocol for immediate loading of multiple implants depends on an adequate fixation and immobility of the implants to prevent the risk of micromovements in relation to the surrounding bone. The objective of this article was to evaluate a prosthetic concept for an accelerated rigid splinting of multiple implants for same‐day immediate loading with metal‐reinforced provisional restorations using a technique of welding temporary implant abutments with a prefabricated titanium bar directly in the oral cavity (syncrystallization). Materials and Methods Between June 2004 and January 2005, immediate loading of threaded implants with a metal‐ reinforced acrylic resin provisional restoration at stage 1 surgery was evaluated in 40 consecutive patients. A total of 192 implants were placed in selected edentulous or partially edentulous patients using the syncrystallization technique. Once the titanium bar was welded intraorally to the abutments, opaque was applied and the provisional restoration was relined and screw‐retained the same day. In addition, a comparison of deformations and stress distributions in implant‐supported, metal‐reinforced and nonmetal‐reinforced resin provisional restorations was analyzed in the edentulous mandible by a three‐dimensional finite element model (FEM). Results All of the 192 rigidly temporized immediately loaded implants osseointegrated. An implant success rate of 100% was achieved over a period of 6 months postplacement. No fracture or luting cement failure of the provisional restoration occurred during the observation time. Compared to mere acrylic superstructures, a significant reduction of deformation and strain within metal‐reinforced provisional restorations was detected by FEM analysis. Conclusion The results of this study indicate that the syncrystallization technique allows an expedite and adequate rigid splinting of multiple immediately loaded implants. The advantages of the technique are: (1) reduction of treatment time for immediate temporization at stage 1 surgery; (2) predictable fixation and immobility of implants in the early stages of bone healing; and (3) less time for repairing provisional restorations as a result of no or rare fracture.     

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.     

牙种植即刻修复的临床研究

目的 探讨牙种植体植入后即刻修复的临床可行性、技术特点并评估其近期临床效果。方法 从1999年3月至2003年12月间,共24例患者行种植体植入后即刻修复。3例无牙颌患者在下颌前部各植入4个专用种植体,1周内完成种植体支持的连杆式上部结构覆盖义齿修复;21例牙列缺损患者共植入30个种植体,均于1周内在种植体上部完成树脂单冠或联冠修复,4-6个月后行种植体烤瓷冠修复。所有患者均于术后1、3、6、12个月,之后每12个月复查1次。结果 24例共42个种植体即刻负重。平均负重28个月(最短3个月,最长49个月),种植体无脱落、无感染,种植体周围未出现X线透影,未见明显骨吸收。患者对修复效果满意。结论 严格掌握适应证和特殊设计的种植系统,应用改良的种植外科和修复技术对一些牙列缺损及无牙颌患者行种植即刻修复,近期疗效满意。     

Immediate maxillary lateral incisor implants with nonocclusal loading provisional crowns.

This clinical report series describes a treatment modality involving immediately placed dental implants in maxillary lateral incisor sites using noncemented immediate provisional crowns retained with calcinable copings (prosthetic complement used in preparing the metal for the definitive prosthesis). Ten implants were placed in eight patients for the replacement of maxillary lateral incisors: two immediate and eight corresponding to cases of agenesis. All were subjected to immediate rehabilitation with provisional acrylic resin crowns in nonocclusal loading. One implant failed 3 weeks after placement due to acute local trauma. The other nine remained functional within the mouth, with normal clinical and radiological characteristics after a minimum of 12-month follow-up. Immediate placement of implant fixed provisional restorations retained by friction in maxillary lateral incisors offers an esthetic solution, eliminates the need for a removable provisional restoration, and avoids implant failures associated with excess cement or screw loosening. Moreover, in the case of extractions, immediate placement and provisionalization of implants in maxillary lateral incisors can effectively optimize the peri-implant esthetic results by maintaining the existing hard and soft tissue architecture of the replaced tooth. As no cement or screws are required, and the provisional crowns are placed in nonocclusal loading, the risk of complications is minimized.     

Immediate provisional restoration of XiVE screw-type implants in the posterior mandible.

OBJECTIVES: This prospective study evaluated the clinical outcome of immediately restored screw-type implants for the replacement of mandibular (pre)molars. The results were based on survival, clinical stability and on changes of bone levels from implant placement to delivery of the definitive superstructure 6 months after insertion. MATERIAL AND METHODS: In this study, 24 patients were treated according to an immediate loading protocol. Forty XiVE implants were placed in the mandibular (pre)molar regions for single-tooth restoration and the treatment of free-end situations. Radiographic bone levels in relation to implant margins were measured at the time of insertion and recorded. All implants were provided with a transfer coping and restored with provisional crowns within 7 days. After 6 months, the final restorations were fabricated. At this time, survival, Periotest value and radiographic bone levels were assessed. RESULTS: A total of 40 XiVE implants were placed with an insertion torque value of at least 45 N cm. The median Periotest value 6 months post-insertion was -5 (maximum -2, minimum -7). The mean radiographic coronal bone level at prosthetic delivery was 1.4 mm (SD+/-0.57) compared with 0.47 mm (SD+/-0.37) at the time of insertion. No implant failures were observed up to prosthetic restoration 6 months post-insertion. CONCLUSION: The present data of immediately loaded implants in the posterior mandible are comparable to results with conventional loaded implants. Additional long-term data will be necessary to include this protocol as a standard procedure in our treatment concepts for the edentulous posterior mandible.     

Restoration with implants in patients with recessive dystrophic epidermolysis bullosa and patient satisfaction with the implant-supported superstructure

PURPOSE: The use of endosseous implants in the prosthetic restoration of edentulous patients with recessive dystrophic epidermolysis bullosa (RDEB) may provide improved outcomes when compared with traditional prosthetic methods. The aim of this study was to evaluate the feasibility of placing endosseous implants in patients with RDEB and to compare the treatment outcomes of fixed and removable implant-supported restorations in the edentulous maxilla or mandible with the main emphasis on patient response. MATERIALS AND METHODS: Six patients with RDEB were treated with implants. All patients were completely edentulous in either the maxilla or mandible and had marked oral involvement, with alterations in the soft and hard tissues in all cases. Three patients were treated with fixed, screw-retained implant-supported prostheses, and 3 were treated with removable implant-supported prostheses. Six months after prosthetic restoration, patients were given a questionnaire to assess their psychologic well-being and satisfaction with the implant-supported restoration marked on a visual analog scale. RESULTS: A total of 38 dental implants (21 maxillary, 17 mandibular) were placed in 6 patients. The implant success rate was 97.9%. The average follow-up from implant placement was 5.5 years (range, 1 to 9). The fixed and removable implant-supported prostheses were associated with improvements in comfort and retention, function, esthetics and appearance, taste, speech, and self-esteem. The level of satisfaction was slightly higher in patients with a fixed prosthesis. CONCLUSION: These findings suggest that endosseous implants can be successfully placed and provide support for prostheses in patients with RDEB. Patients with fixed prostheses and overdentures were satisfied with their implant-supported prostheses in the edentulous maxilla and mandible.     

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.     

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.     

Replacement of mandibular molars with single-unit restorations supported by wide-body implants: immediate versus delayed loading. A randomized controlled study

PURPOSE: This prospective randomized controlled trial aimed to compare single implant-supported mandibular molar restorations using either an immediate or a delayed loading protocol. MATERIALS AND METHODS: Thirty subjects requiring single mandibular molar replacement were consecutively treated. One implant was placed in each patient. Fifteen subjects were assigned to delayed loading protocol and 15 to immediate loading protocol according to a randomization table. After insertion, the delayed loaded implants were connected to a healing abutment and restored after 3 to 4 months of healing without loading. The immediately loaded implants were loaded within 24 hours of surgery with a provisional restoration. The interim prosthesis was placed in centric occlusion. All contacts in lateral excursions were eliminated. At implant placement the maximum value of insertion torque was recorded. Radiographic bone level change was measured on periapical radiographs obtained at the time of implant placement and 12 months after loading. Means of the 2 groups were compared by Student t test and analysis of variance (ANOVA). The level of significance was set at .05. RESULTS: No implants were lost in the delayed loading group (0/15), whereas 1 implant failed (1/15) in the immediate loading group. No differences were observed in relation to implant length or insertion torque between the groups. The average radiographic bone level change after 1 year of function was 1.2 +/- 0.55 mm (range, 0.5 to 2.6 mm) and 0.77 +/- 0.38 mm (range, 0.29 to 1.23 mm) for the delayed loaded and the immediately loaded implants, respectively. The difference in radiographic bone level change between the delayed and immediate loading groups was statistically significant (P = .022; CI = -0.79 to -0.06; Student t test). CONCLUSIONS: Immediate loading of wide-diameter implants supporting single restorations in mandibular molar sites seems to be a suitable clinical option. Moreover, the radiographic bone level change observed after 12 months of loading was significantly less for immediately loaded implants.     

A Prospective Multicenter Study Evaluating Loading of Osseotite Implants Two Months After Placement: One-Year Results

Abstract: Historically, the recommended time between placement and functional loading of machined-surface dental implants has been 3 months for the mandible and 6 months for the maxilla. However, such recommendations are a result of evaluating randomly chosen healing times during the initial phase of implant development and are based on the subsequent clinical outcome of either implant integration or mobility. In recent years, histologic and experimental studies have shown that specifically designed micro-topographic implant surfaces can result in increased bone-to-implant contact at earlier healing times than obtained with machined-surface implants. Histologic and clinical studies investigating early and immediate implant loading support the premise that implants can be placed into function earlier than previously recommended. With the development of specifically designed implant surfaces and the utilization of time-saving surgical (one-stage surgical protocol) and prosthetic (implant position indexing) techniques, patients are now being restored and returning to function sooner than previously thought possible. The purpose of this multicenter clinical investigation is to evaluate the efficacy of loading Osseotite dental implants (3i-Implant Innovations Inc., Palm Beach Gardens, Florida) at 2 months and to determine the effect of early loading on implant performance and survival. A total of 429 Osseotite implants were placed in 155 patients (87 females and 68 males; mean age 54.0 ± 13.7 yr), at 10 study centers, and subsequently loaded 2.1 ± 0.7 months following placement. A single-stage surgical protocol was followed, with implants indexed immediately or impressed 4 to 6 weeks following placement. Patient restorative treatments included placement of 83 single-implant provisional restorations and 129 splinted, two-, three-, and four-implant supported maxillary and mandibular provisional restorations. The mean time from prosthetic loading to the most recent follow-up evaluation was 10 ± 1.3 months. Seven of the 429 implants did not integrate; of these, six were identified prior to loading and one was identified 1 month after loading. The cumulative implant survival rate was 98.5% at 12.6 months. The cumulative post-loading implant survival rate was 99.8% at 10.5 months. The preliminary results of this clinical investigation suggest that successful functional loading of the Osseotite dental implant is possible at 2 months following noncomplicated implant placement.     

A prospective multicenter study evaluating loading of osseotite implants two months after placement: one-year results.

Historically, the recommended time between placement and functional loading of machined-surface dental implants has been 3 months for the mandible and 6 months for the maxilla. However, such recommendations are a result of evaluating randomly chosen healing times during the initial phase of implant development and are based on the subsequent clinical outcome of either implant integration or mobility. In recent years, histologic and experimental studies have shown that specifically designed micro-topographic implant surfaces can result in increased bone-to-implant contact at earlier healing times than obtained with machined-surface implants. Histologic and clinical studies investigating early and immediate implant loading support the premise that implants can be placed into function earlier than previously recommended. With the development of specifically designed implant surfaces and the utilization of time-saving surgical (one-stage surgical protocol) and prosthetic (implant position indexing) techniques, patients are now being restored and returning to function sooner than previously thought possible. The purpose of this multicenter clinical investigation is to evaluate the efficacy of loading Osseotite dental implants (3i-Implant Innovations Inc., Palm Beach Gardens, Florida) at 2 months and to determine the effect of early loading on implant performance and survival. A total of 429 Osseotite implants were placed in 155 patients (87 females and 68 males; mean age 54.0 +/- 13.7 yr), at 10 study centers, and subsequently loaded 2.1 +/- 0.7 months following placement. A single-stage surgical protocol was followed, with implants indexed immediately or impressed 4 to 6 weeks following placement. Patient restorative treatments included placement of 83 single-implant provisional restorations and 129 splinted, two-, three-, and four-implant supported maxillary and mandibular provisional restorations. The mean time from prosthetic loading to the most recent follow-up evaluation was 10 +/- 1.3 months. Seven of the 429 implants did not integrate; of these, six were identified prior to loading and one was identified 1 month after loading. The cumulative implant survival rate was 98.5% at 12.6 months. The cumulative post-loading implant survival rate was 99.8% at 10.5 months. The preliminary results of this clinical investigation suggest that successful functional loading of the Osseotite dental implant is possible at 2 months following noncomplicated implant placement.     

Evaluating the clinical performance of the Osseotite implant: defining prosthetic predictability

A 5-year prospective, multicenter study is in progress at four private dental practices to determine the cumulative implant survival rate and prosthetic outcome when using the Osseotite dental implant in posterior maxillary and mandibular areas. An interim evaluation after 34.4 months of study progress is presented. A total of 219 Osseotite implants were placed in 74 patients (34 women and 40 men with a mean age of 57.8 +/- 15.2 years) using a conventional two-stage surgical protocol and 3- to 6-month healing time. Subsequently, patients were restored with fixed or removable restorations. Nineteen of the 74 patients reported smoking an average of 13.2 cigarettes per day. Restorative treatments included 40 single-unit restorations; 53 splinted 2-, 3-, 4-, and 5-unit implant-supported maxillary and mandibular prostheses; 4 full-arch fixed maxillary prostheses; 1 mandibular fixed/detachable hybrid prosthesis; and 1 mandibular overdenture. The mean time from implant placement to second stage surgery was 6.2 +/- 2.0 months; from restoration and implant loading to the most recent follow-up evaluation was 20.9 +/- 6.8 months. Of the 219 implants placed, three posterior maxillary implants developed infections and were removed prior to second stage surgery. No implant failures occurred at second stage surgery or after implant loading. Using the Kaplan-Meier method, the cumulative implant survival rate was 100% for anterior implants and 98.4% for posterior implants at 28.5 +/- 5.7 months. The cumulative postloading implant survival rate was 100% for both anterior and posterior implants. The results of this study indicate that the Osseotite dental implant achieved a high rate of integration that remained stable during nearly 2 years of implant function. In addition, because no postloading implant failures have occurred, the Osseotite implant has provided a high level of prosthetic predictability.     

Immediate loading of mandibular overdentures supported by unsplinted direct laser metal-forming implants: results from a 1-year prospective study

Background: At present, only some studies have dealt with immediate loading of unsplinted implants supporting mandibular overdentures. The aim of this prospective study is to evaluate treatment outcomes of mandibular overdentures supported by four one‐piece, unsplinted, immediately loaded, direct laser metal‐forming (DLMF) implants by assessing implant survival rate, implant success, marginal bone loss, and prosthetic complications. Methods: A total of 96 one‐piece DLMF implants were inserted in the edentulous mandible of 24 patients. Four implants were placed in each edentulous mandible. Immediately after implant placement, a mandibular overdenture was connected to the implants. At 1‐year follow‐up, clinical, radiographic, and prosthetic parameters were assessed. Success criteria included absence of pain, suppuration, and implant mobility; absence of continuous peri‐implant radiolucency; and distance between the implant shoulder and the first visible bone contact <1.5 mm. Results: After a 1‐year loading time, the overall implant survival rate was 98.9%, with only one implant lost. Among the surviving 95 implants, two did not fulfill the success criteria; therefore, the implant success rate was 97.8%. The mean distance between the implant shoulder and the first visible bone contact was 0.28 ± 0.30 mm (95% confidence interval, 0.24 to 0.32). Some prosthetic complications were reported. Conclusion: Based on the present results and within the limits of this study, the immediate loading of four unsplinted DLMF implants by means of ball attachment–supported mandibular overdentures seems to represent a safe and successful procedure.     

A new device in immediately loaded implant treatment in the edentulous mandible

PURPOSE: This article reports preliminary clinical results of the Speed Master system, a method for immediate loading of implants for the treatment of mandibular edentulism. MATERIALS AND METHODS: Fifteen patients with edentulous mandibles were consecutively included in the study. Each received 4 implants between the mental foramina placed using the system's surgical guides. Permanent fixed prostheses fabricated over premanufactured titanium bars were attached to the implants on the day of implant placement. The patients were followed for 15 to 27 months (mean, 19 months). Peri-implant tissues were periodically evaluated. Marginal bone loss was monitored with periapical radiographs using a computerized technique. Satisfaction was assessed by means of a questionnaire. RESULTS: The overall implant and prosthetic survival rates were 100%. At the time of the final follow-up visit, mean marginal bone loss was 1.11 mm, and bleeding on probing was not observed. Only 6.7% of the patients reported any discomfort during treatment, and all patients would recommend the procedure to others. DISCUSSION: The immediate loading of implants placed in the edentulous mandible with the Speed Master surgical and prosthetic protocol reduces treatment time and number of surgical procedures in comparison to classic delayed loading protocols. CONCLUSION: The rehabilitation of the mandible with an immediately delivered occlusally loaded hybrid prosthesis supported by 4 implants does not appear to jeopardize the success of the osseointegration and represents a viable treatment     

Survival of immediately loaded dental implants in deficient alveolar bone sites augmented with beta-tricalcium phosphate

PURPOSE: Dental implant placement in atrophic alveolar ridges often necessitates grafting procedures, followed by immediate or delayed implant placement. This study assessed the survival of immediately loaded dental implants placed in deficient alveolar bone sites at bone grafting. MATERIALS: From 1999 to May 2002, 1 operator (A.P.) inserted 1065 implants (607 in mandibles, 458 in maxillae) into 338 partially edentulous patients. Most implants were placed into compromised residual ridges or prepared tooth extraction sockets. Implants placed in augmented areas were splinted to implants in nonaugmented sites for stability. In all cases, beta-tricalcium phosphate was mixed with blood from the surgical site to augment the ridge level or fill spaces between the implant and socket wall. When indicated, the same materials were used for sinus floor augmentation. All implants were tapered screws with roughened surfaces, primarily (75%) from 1 manufacturer. One of the authors (Z.O.) prosthetically restored a total of 189 implants that were placed in 35 patients. In this group of patients, complete restorative data were available. All implants were monitored for 12-48 months (mean = 19.2; median = 24). RESULTS: A total of 1039 implants survived, and 26 failed, including 5 in the anterior mandible and 21 in the maxillae. In the restorative group, 186 implants survived, and 3 maxillary implants failed. All implant failures in this study occurred in the augmented sites. CONCLUSION: Within the limitations of this study, immediate loading of splinted implants in augmented sites is a predictable procedure.     

Resonance frequency analysis in immediate loading of dental implants

Immediate loading of dental implants aims to shorten treatment time. Stability at implant insertion is critical to success. The aim of this prospective study is to compare primary implant stability, measured by insertion torque (IT) with resonance frequency analysis (RFA) expressed as ISQ. Patients requiring implant therapy were treated by teeth extractions, placement of 1-9 MIS implants, bone augmentation as needed and fixed provisional restorations. We measured IT and ISQ for non-submerged loaded (NSL), non-submerged non loaded (NSNL) and submerged (S) implants. 14 patients, aged 34-79 years, were recruited. 53 implants were inserted (38 maxillary & 15 mandibular). 30 implants, 18 in fresh extraction sites, were immediately loaded. ISQ was 63.3 +/- 2.8 (S.E.), 67.2 +/- 3.5 (S.E.) and 58.8 +/- 2.7 for the NSL, NSNL and S groups, respectively (p = 0.0459). IT was 40.4 +/- 1.8 Ncm, 46 +/- 4.0 and 35.3 +/- 2.1 (p = 0.0646). ISQ and IT were not statistically different between extraction vs. non-extraction and augmented vs. non-augmented sites. We found a significant difference in IT between maxillary & mandibular sites, and a significant correlation between ISQ & IT and between ISQ & implant diameter. These data suggest that ISQ is correlated to IT and is influenced mainly by implant diameter and not by implant length, location or bone level. Finally, a case including immediate implants, bone augmentation and immediate provisional restoration is presented.     

Immediate loading of Brånemark system implants following placement in edentulous patients: a clinical report

The purpose of this study was to evaluate the immediate loading of Br?nemark System implants following placement with a screw-retained provisional prosthesis in edentulous patients. Twelve mandibular and 5 maxillary arches were treated from December 1997, including 3 bimaxillary patients. The provisional prosthesis, made of heat-polymerizing resin, had an inner casting of cobalt-chromium alloy to provide rigidity. The implants whose placement torque was more than 40 Ncm were immediately loaded. Implants that were placed with placement torque of less than 40 Ncm or that were associated with bone grafting were submerged. Following abutment connection, temporary cylinders were incorporated into the provisional prosthesis intraorally with autopolymerizing resin. After the provisional prosthesis was completed extraorally, it was screw-retained. After a 4- to 6-month healing period, a definitive prosthesis was fabricated and placed. Of the 140 immediately loaded implants, 136 osseointegrated during an 8- to 24-month follow-up period (97.2%). All 17 submerged implants osseointegrated. The results suggest that immediate loading of Br?nemark System implants at the time of placement in edentulous patients can be a valuable adjunct to therapy and as predictable as delayed loading, in both mandibular and maxillary arches.