Immediate functional loading of Brånemark system implants in edentulous mandibles: clinical report of the results of developmental and simplified protocols

PURPOSE: This report evaluates the 5-year results of 9 of 10 patients in a clinical investigation of immediate functional loading of Br?nemark System implants in edentulous mandibles, and of 24 patients treated with a simplified protocol for the same indication. The purpose of the paper is to suggest a simple, reliable, and documented method for immediate implant loading of complete-arch mandibular prostheses. MATERIALS AND METHODS: Ten healthy patients in need of full-arch mandibular implant reconstruction (development group) were treated between December 1993 and December 1994 with 130 Br?nemark System standard Implants, placed in fresh extraction and healed sites. Four implants per patient were immediately loaded with acrylic resin fixed prostheses. The prostheses were replaced by metal-framework conversion prostheses approximately 6 weeks later, and definitive metal-reinforced prostheses incorporating all implants were placed after second-stage surgery. An additional 24 patients were treated with a simplified protocol using a total of 144 implants placed between March 1997 and October 2000. In these patients, the acrylic resin prostheses were not disturbed for 3 months, and fewer implants were used with an increasing ratio of implants loaded. Eventually, all Implants were loaded immediately for the last patients treated. RESULTS: The prosthesis survival rate was 100% for the total material. In the developmental group, the implant cumulative survival rate was 80% for the immediately loaded implants after 5 years, while the 2-stage implants reached 96%. Bone level measurements showed no differences between immediate and 2-stage protocols for this group. The implant cumulative survival rate was 97% for the simplified treatment group. DISCUSSION AND CONCLUSION: A predictable and simple concept for loading of immediate implant prostheses in edentulous mandibles was demonstrated. Results from the development of this technique suggest that it may be essential to maintain the initial implant splinting over a healing period of about 3 months and that implant placement between the mental foramina provides optimal support.     

Immediately loaded implants supporting fixed prostheses in the edentulous maxilla: a preliminary clinical and radiologic report

PURPOSE: To evaluate the survival rate of immediately loaded ITI sand-blasted, large-grit, acid-etched (SLA) solid-screw dental implants in the edentulous maxilla after 8 months of loading. MATERIALS AND METHODS: Twenty-eight patients (mean age 63 years) with edentulous maxillae each received 6 implants and 1 implant-supported fixed provisional prosthesis within 24 hours after surgery. After a mean healing time of 15 weeks, the patient received a definitive, screw-retained, implant-supported fixed prosthesis. A total of 168 implants were placed. Clinical parameters were registered after 1 month of loading with the implant-supported fixed prostheses as well as 8 months after implant placement. Radiologic examinations and assessments were made at implant placement and after 8 months. RESULTS: The mean marginal bone level at implant placement was 1.6 mm (range 0 to 5.1; SD 1.1) apical of the reference point (the implant shoulder). The mean marginal bone level at the 8-month follow-up was 3.2 mm (range 0.4 to 5.9; SD 1.1) apical of the reference point. Three implants failed during the healing period. DISCUSSION: The improved results in the present study might be a result of the positive effect of splinting the implants immediately after placement. CONCLUSION: ITI SLA solid-screw implants immediately loaded (ie, loaded within 24 hours of placement) and supporting fixed prostheses had successful survival rates after 8 months. The present results constitute a solid baseline for future follow-up studies.     

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 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.     

In-patient comparison of immediately loaded and non-loaded implants within 6 months

Abstract: According to the Brånemark protocol, a stress‐free healing period is one of the most emphasised requirements for implant integration. Recent studies have encouraged a progressive shortening of the healing period and immediate loading has been proposed for the edentulous mandible. This prospective study evaluated the clinical outcomes of 14 immediately loaded FRIALIT‐2^® implants compared with 28 non‐loaded controls in an in‐patient study. The results were based on clinical stability and on changes of bone level from implant placement to abutment connection 6 months after insertion. In the course of our investigation, seven patients with edentulous mandibles have been treated with 43 implants following an immediate‐loading protocol. Six FRIALIT‐2^® implants were placed in the interforaminal region located at positions 34, 33, 32, 42, 43, 44. Bone level in relation to implant margin was measured and recorded. In order to obtain an in‐patient comparison of immediately loaded and non‐loaded implants, the ones at 33 and 43 were chosen to be immediately loaded by a Dolder‐bar retained overdenture. The implants in position 32, 34, 42 and 44 were covered and left to heal. After a healing period of 6 months, second stage surgery was carried out. The clinical criteria to be checked at this point were survival, Periotest values and marginal bone level at the loaded and non‐loaded implants. The mean Periotest value was ?2.7 for the loaded and ?5.6 for the non‐loaded implants. The Mann–Whitney U‐test showed that the difference was highly significant (P < 0.001). The mean bone level changes at prosthetic delivery were 0.9 mm resorption for the loaded implants and 0.33 mm for non‐loaded implants. The difference was highly significant (P < 0.001). No implant failures were observed up to the prosthetic restoration 6 months post insertion. The results of this investigation allowed for direct comparison of implant survival and clinical results between immediately loaded implants and standard implants. Clinical bone changes at the 6‐month evaluation demonstrated significantly higher crestal resorption around loaded implants. This fact was confirmed by higher median Periotest values (?3 vs. ?6) of immediately loaded implants. According to the outcome of this study, immediate loading of two interforaminal implants with a Dolder‐bar resulted in an intimate bone apposition comparable with implants with submerged healing. Nevertheless, the coronal bone level as well as clinical stability (PTV) were significantly lower in the case of the immediately loaded implants. Future studies will be necessary to evaluate marginal bone resorption, Periotest values and clinical success rates of mandibular immediately loaded implants in the long‐term.     

Marginal bone loss adjacent to conventional and immediate loaded two implants supporting a ball-retained mandibular overdenture: a 3-year randomized clinical trial

Objectives: The aim of this study was to evaluate and compare marginal bone loss and clinical outcomes of conventionally and immediately loaded two implants supporting a ball‐retained mandibular overdenture. Materials and methods: Thirty six completely edentulous patients (22 males and 14 females) were randomly assigned into two groups. Each patient received two implants in the canine area of the mandible after a minimal flap reflection. Implants were loaded by mandibular overdentures either 3 months (conventional loading group) or the same day (immediate loading group) after implant placement. Ball attachments were used to retain all overdentures to the implants. Vertical and horizontal alveolar bone losses were evaluated in both groups 1 and 3 years after implant placement using multislice computed tomography, which allow evaluation of peri‐implant buccal and lingual alveolar bone. Plaque scores, gingival scores, probing depths and periotest values (PTVs) were evaluated at 4 months (baseline), 1 and 3 years after implant placement. Clinical and radiographic evaluations were performed at distal, labial, mesial and lingual peri‐implant sites. Results: After 3 years of follow‐up period, the immediate loading group recorded significant vertical bone loss at distal and labial sites than the conventional loading group and no significant differences in horizontal bone loss between groups were observed. Probing depth at distal and labial sites in the immediate loading group were higher than the conventional loading group, while plaque scores, gingival scores and PTVs showed no significant differences between the two groups. A low level of positive correlation between plaque scores, gingival scores, probing depths and vertical bone loss was noted. Conclusion: Immediately loaded two implants supporting a ball‐retained mandibular overdenture are associated with more marginal bone resorption and increased probing depths when compared with conventionally loaded implants after 3 years. The bone resorption and probing depths at distal and labial sites are significantly higher than those at mesial and lingual sites. Clinical outcomes do not differ significantly between loading protocols. To cite this article :
Elsyad MA, Al‐Mahdy YF, Fouad MM. Marginal bone loss adjacent to conventional and immediate loaded two implants supporting a ball‐retained mandibular overdenture: a 3‐year randomized clinical trial.
Clin. Oral Impl. Res. 23 , 23, 2012 496‐503.
doi: 10.1111/j.1600‐0501.2011.02173.x     

Immediate functional load of mandibular implant overdentures: a surgical and prosthodontic rationale of 2 implant modalities

Classic guidelines in osseointegration for root-form dental implants include a long healing period, during which functional load should be avoided. However, the long healing period might impose an intolerable situation on some patients, especially in the completely edentulous situation. Subperiosteal dental implant guidelines demonstrate that the implant upon insertion can be put into immediate function and be restored with the final prosthesis soon after surgery. Studies on immediately functional loaded implant-supported prostheses in patients who are completely edentulous have been reported, exhibiting high success rates comparable with conventionally loaded implants. This article describes the surgical and prosthodontic procedure for the immediately functional loaded mandibular implant overdentures in 2 different dentalimplant modalities, as well as its clinical rationale.     

Immediate Occlusal Loading of Osseotite® Implants in Mandibular Edentulous Patients: A Prospective Observational Report with 18-Month Data

PURPOSE: To evaluate the efficacy of treatment consisting of placement and immediate occlusal loading of implants in 27 patients with edentulous mandibles. MATERIALS AND METHODS: Twenty-seven patients were treated in two private practice settings. One hundred fifty-one implants were placed and immediately occlusally loaded with fixed implant prostheses (15 cement-retained, 12 screw-retained) on the day of implant placement. The implant-retained prostheses were inserted within 5 hours of implant placement. Patients were followed for at least 18 months. The required criteria for immediate occlusal loading was primary implant stability of at least 30 Ncm of insertion torque. The implant prostheses were removed at least 12 months post-placement and the implants were evaluated for primary clinical stability and radiographic bone apposition to implants. RESULTS: At the 12-month follow-up appointments, cumulative survival rates of 98.0% and 100% were recorded for implants and prostheses, respectively. Three implants failed within 3 months. All other implants were clinically successful. CONCLUSIONS: Immediate occlusal loading of multiple, splinted mandibular implants is an effective treatment when implants are stable at insertion and are rigidly splinted with implant-retained prostheses.     

Immediate non-occlusal vs. early loading of dental implants in partially edentulous patients: a multicentre randomized clinical trial. Peri-implant bone and soft-tissue levels

Objectives: To compare peri‐implant bone and soft‐tissue levels of immediately non‐occlusally loaded vs. non‐submerged early loaded implants in partially edentulous patients up to 14 months after placement. Material and methods: Fifty‐two patients were randomized in five Italian private practices: 25 in the immediately loaded group and 27 in the early loaded group. To be immediately loaded, single implants had to be inserted with a torque of ≥30 N cm, and splinted implants with a torque of ≥20 N cm. Immediately loaded implants were provided with non‐occluding temporary restorations within 48 h. After 2 months, the provisional restorations were placed in full occlusion. Implants were early loaded after 2 months. Final restorations were provided 8 months after placement. Blinded assessors evaluated peri‐implant bone and soft‐tissue levels. Results: Fifty‐two implants were immediately loaded and 52 were early loaded. No drop‐out occurred. One single immediately loaded implant failed 2 months after placement. Both groups gradually lost peri‐implant bone in a highly statistically significant manner at 2, 8, and 14 months. After 14 months, patients of both groups lost an average of 1.1 mm of peri‐implant bone. There were no statistically significant differences between the two loading strategies for peri‐implant bone and soft‐tissue level changes (P>0.05). After 14 months, the position of the soft tissues did not change significantly from baseline (delivery of the final restorations 8 months after placement). Conclusions: There were no statistically or clinically significant differences between immediate and early loading of dental implants with regard to peri‐implant bone and soft‐tissue levels as evaluated in the present study.     

Immediate loading of implants with fixed restorations in the completely edentulous mandible: report of 27 patients from a private practice.

Numerous authors have documented clinical success in loading threaded implants at the time of implant placement when carefully controlled surgical and restorative protocols are followed. This clinical series documents the application of immediate loading techniques to fixed mandibular restorations in 27 patients who were edentulous or had non-restorable mandibular dentitions. Eighteen patients had complete conventional maxillary dentures, while 9 had natural or fixed prosthetic maxillary dentitions. Twelve different restorative dentists provided prosthetic support for these patients and used 4 different restoration types: laboratory- or office-processed, with cement or screw retention. Five to 8 threaded implants were placed in each patient. One hundred sixty-one of the 186 implants that were placed by the authors were loaded immediately using fixed provisional restorations of the various designs. More than 99% (160/161) of the immediately loaded implants and 99.5% (185/186) of all implants were clinically integrated and radiographically successful at the time of final evaluation for restoration fabrication. After final implant evaluation, no additional implant losses occurred, indicating an implant survival rate of nearly 100% over a mean of 25.0 months (range 13 to 41 months) following implant placement. While a strong preference for cement-retained restorations was apparent, all prostheses showed similar success. The data and the experience described in this report indicate that immediate loading with fixed restorations using appropriate surgical and restorative techniques can be a predictable technique for rehabilitation of the completely edentulous mandible.     

Immediate loading with mini dental implants in the fully edentulous mandible

The use of immediate loaded prostheses is not recommended for at least 2 weeks to prevent implants from premature loading. In addition, immediate removable prostheses are negated for at least 4 weeks at the site of guided bone regeneration or bone graft. However, patients are often not pleased with limited diets and the unaesthetic appearance during the healing period without a denture between implant placement and final prosthesis. Mini dental implants provide stable and esthetic temporary prostheses immediately after implant placement and bone grafts. The use of mini dental implants is simple and cost effective because the patient's old denture is used as a provisional prosthesis. This article shows the success of 27 mini dental implants that were placed for 11 mandibular fully edentulous patients.     

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 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.     

Single mandibular implant study – denture satisfaction in the elderly

To investigate whether there are differences in patients’ denture satisfaction when an implant placed in the midline of the edentulous mandible is loaded either immediately or three months later, after second‐stage surgery. One hundred and fifty‐eight edentulous patients received a single implant in the midline of the mandible. After randomisation, it was loaded either immediately after implant placement (N = 81, group A) or three months later, after a submerged healing phase and a second‐stage surgery (N = 77, group B). Patients’ denture satisfaction aspects were assessed, using visual analogue scales (VAS), before treatment, one month after implant placement during the submerged healing phase (only group B) and one and four months after implant loading. The statistical analysis was performed using the Wilcoxon signed‐rank and rank‐sum tests. One month after loading, a significant improvement in comfort, function and stability of the mandibular denture could be observed in both groups (P ≤ 0·05). A slight but not significant improvement was found between one and four months after loading. Patients with second‐stage surgery and delayed loading rated the stability and fit of the mandibular denture as significantly better than patients who had immediate loading. A single implant in the edentulous mandible significantly increased patients’ denture satisfaction. After four months, stability and fit of the mandibular denture were considered better when a delayed loading protocol had been followed. A single mandibular implant in the edentulous mandible significantly increases patients’ denture satisfaction, regardless of the loading protocol.     

Immediately loaded mandibular implant bar overdenture: a surgical and prosthodontic rationale

Classical guidelines for osseointegration include a long healing time, during which functional load should be avoided. However, the long healing period might impose an intolerable situation on some patients, especially in the completely edentulous situation. Studies on immediately loaded implant-supported prostheses in completely edentulous patients have been reported, exhibiting high success rates comparable to conventionally loaded implants. This article describes the surgical and prosthodontic procedure for the immediately loaded mandibular implant bar overdenture as well as its clinical rationale.     

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.     

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

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

Early loading of implants with fixed dental prostheses in edentulous mandibles: 4.5‐year clinical results from a prospective study

Aim: The purpose of this study was to evaluate the survival and success of early‐loaded implants placed in the intraforaminal area of the edentulous mandible, and the survival of the implant‐supported fixed dental prostheses (FDP). Material and methods: Thirty‐seven patients (18.9% male, mean age 64.5 years) with edentulous lower jaws were treated with implant‐supported FDPs in the mandible. One hundred and eighty‐five screw‐type implants were placed in the intraforaminal area of the symphysis (five implants per patient). Immediately after implant placement, a framework was fabricated and the FDP was manufactured on the framework. Within 2 weeks, the implants were rigidly connected and loaded with the implant‐retained FDP. Results: During the 1–8‐year observation period (mean 4.5 years), a total of 32 implant‐retained complications occurred. Nineteen implants were lost in 10 patients, resulting in a cumulative survival of 89.7%. Nine implants in five patients did not osseointegrate. Although these implants were not removed, because stability within the connective tissue was acceptable and inflammation was absent, they were recorded as unsuccessful. Consequently, the cumulative success declined to 84.9%. Four implants in three patients had clinical signs of periimplantitis (2.2% of all implants). Denture‐related complications included one complete failure, when one FDP had to be removed after the last of five implants had been replaced. Furthermore, 10 fractures of the framework occurred in six patients, three FDPs had to be adapted or modified, and the facing of the FDP had to be repaired 16 times in 11 patients. Conclusion: Although one‐stage early‐loaded implants functioned well for most patients with edentulous mandibles, immediate loading is associated with a larger number of implant‐related complications than in other studies investigating delayed loading. Because of the substantial prosthetic complications and aftercare, this procedure cannot be generally recommended. To cite this article:
Schwarz S, Gabbert O, Hassel A J, Schmitter M, Séché C, Rammelsberg P. Early loading of implants with fixed dental prostheses in edentulous mandibles: 4.5‐year clinical results from a prospective study.
Clin. Oral Impl. Res. 21 , 2010; 284–289.
doi: 10.1111/j.1600‐0501.2009.01843.x     

“All-on-4”种植即刻修复技术的临床应用研究

目的：评价应用＂All-on-4＂种植即刻修复技术对牙列缺失患者进行种植即刻修复的临床效果,探讨其技术要点及临床意义。方法：2008年4月至2009年11月共29例患者（男15例,女14例）接受了＂All-on-4＂种植即刻修复。29例（上无牙颌8例,下无牙颌15例,双颌无牙颌6例）共植入140枚种植体,在种植体植入当天完成即刻修复,一共完成35件＂All-on-4＂即刻义齿。即刻修复后观察种植体边缘骨吸收情况、追踪种植体和即刻修复体的存留率、患者满意率。平均追踪14.8个月（10～29个月）。结果：140枚种植体中,8枚于植入后6～8周脱落。其余132枚种植体至最后一次复查临床稳定,种植体存留率：94.3%。上颌种植体存留率89.3%,下颌种植体存留率97.8%,存在统计学差异（p〈0.05）。即刻修复义齿的存留率94%（33/35）。边缘骨吸收程度为（0.8±0.4）mm。患者满意率100%。结论：＂All-on-4＂种植即刻修复技术应用于无牙颌患者近期效果好,患者满意度高。远期效果需要进一步观察。     

Immediate loading of dental implants placed in severely resorbed edentulous maxillae reconstructed with Le Fort I osteotomy and interpositional bone grafting

Background: Reconstruction and rehabilitation of atrophic maxillae with bone grafts is a lengthy and demanding procedure. This study reports the immediate loading of 50 implants placed on six extremely atrophied edentulous maxillae reconstructed with Le Fort I osteotomy and iliac bone grafting. Methods: Six patients, aged 49 to 68 years, with severely atrophied maxillae were treated with Le Fort I osteotomy and iliac bone grafting to allow for implant‐borne prosthetic rehabilitation. Four to 5 months thereafter, 50 implants (seven to 10 per patient) were placed in reconstructed maxillae and immediately functionally loaded with a screw‐retained definitive prosthesis. The patients were followed by clinical and radiographic examinations for 24 months after prosthetic loading. Results: The grafting procedure and healing period before implant placement were uneventful in all patients. Two implants were lost within 2 months after prosthesis insertion in two patients, with an overall survival rate of 96%. The prostheses success rate was 100%. At the end of the follow‐up period, all remaining implants appeared clinically healthy; crestal bone loss was >1.7 mm for six implants, resulting in a cumulative success rate of 84%. Conclusion: Immediate loading of implants placed after Le Fort I osteotomy and interpositional iliac bone grafting could be considered a viable protocol to rehabilitate extremely atrophied edentulous maxillae, considerably reducing the treatment time.