A 5-year prospective clinical trial on short implants (6 mm) for single tooth replacement in the posterior maxilla: immediate versus delayed loading

Success rate of immediately loaded implants in the posterior zone

Dental implants are considered an ideal treatment for a missing single tooth. Immediate loading of implants can hasten the procedure, providing comfort to the patients. Recently, immediate loading of implants has gained much importance as it helps hasten the procedure and provides more comfort to patients. A previous systematic review published 5 years ago compared the success rates between immediate and conventional loading. There are several factors that influence the success rate of implants that were not discussed in detail in the previous review. Hence, the present systematic review is done to report differences in the outcomes from single implant restorations of missing teeth in the posterior region in patients who were subjected to immediate loading and conventional loading. A follow up for 1 year was done. Electronic databases of Medline, Scopus, and Web of Science were searched for publications in the English Language during May 2021. The search results yielded 306 articles, out of which 225 were excluded based on title and abstract screening. Screening of the remaining 81 full text articles yielded 14 original research articles that satisfied the predefined inclusion criteria. Meta analysis was not possible due to the heterogeneity of the data. The overall success rate of the immediate loading of a single implant is 94.31%. Implants in the maxillary region had a higher survival rate than those in the mandibular region. The age range between 18 and 80 years showed good prognosis and outcomes in older individuals. Good oral hygiene was emphasized for all patients to prevent any secondary conditions or delays in healing.

Patient's perception of timing concepts in implant dentistry: A systematic review

Protocols for implant dentistry, most frequently include periods until healing of the extraction sockets and osseointegration of the implant. Deductional thinking imply that patients would prefer if treatment time in implant dentistry were reduced.

AIM

What is the patient perception of immediate or early implant placement or loading in comparison with traditional, delayed placement, and/or loading assessed by patient-reported outcome measures, as evidenced in randomized controlled clinical trials or prospective controlled studies?

MATERIAL AND METHODS

A systematic review was performed following the PRISMA guidelines with a literature search up to June 30. All hits were imported into Rayyan online software and analyzed by two authors for eligibility. Cochrane RoB2.0 and Newcastle-Ottawa Scale were used to evaluate risk of bias in the individual studies.

RESULTS

Of the initially 1439 articles, 76 underwent full-text analysis and finally 40 articles, representing 35 cohort studies, were included. The quality evaluation demonstrated some concerns among most of the studies.

CONCLUSION

a) There is no strong evidence to support that the time for implant placement or loading of implant-supported single or short-span reconstructions or overdentures influence patients´ discomfort, satisfaction with function or esthetics or overall satisfaction with the implant treatment. b) There is some evidence that studies including edentulous patients rehabilitated with implant-supported full-arch FDPs demonstrate more satisfied patients with immediate than for the early or delayed loaded implant reconstructions after short time, but the difference is not clear one year after treatment.

Failure Risk of Short Dental Implants Under Immediate Loading: A Meta-Analysis

PURPOSE

Currently, there is no clear clinical evidence that short implants are suitable for immediate loading. Therefore, this meta-analysis aims to evaluate whether immediate loading increases the failure risk of short dental implants.

MATERIALS AND METHODS

This meta-analysis was registered at PROSPERO (CRD 42020195890). PubMed, Embase, and Cochrane Library databases were searched to collect all clinical studies comparing the failure rates of short dental implants (<10 mm) and standard implants (≥10 mm) under the condition of immediate loading and studies comparing the failure rates of short dental implants under immediate loading versus early or delayed loading. All of the clinical studies with available relevant data were eligible for inclusion. The Cochrane Risk of Bias tool was adopted to evaluate the risk of bias for the randomized controlled trial (RCT), while Newcastle-Ottawa Quality Assessment Scale (NOS) was used for the observational studies (OS). The OR value of each included study and its 95% CI were pooled to estimate the failure risk of short dental implants under immediate loading. The heterogeneity among studies was evaluated through Cochran's Q test and I² .

RESULTS

Seventeen studies, 5 RCTs and 12 OS studies, with a total of 2461 dental implants were analyzed. Four of the RCT studies were of low risk of bias and one was of unclear risk, while all of the OS studies were of moderate or high quality. Compared with standard implants, short implants did not have an increased failure risk under immediate loading (OR: 1.38, 95% CI: 0.67-2.84, p = 0.997, fixed model). In addition, the OR value of implant failure for short implants under immediate loading compared to that for short implants under early or delayed loading was 1.22 (95% CI: 0.33-4.55, p = 0.104, random model), which was also not significantly different.

CONCLUSIONS

There is not enough evidence to show that short dental implants under immediate loading may have higher implant failure risk compared to standard implants under immediate loading and short implants under early or delayed loading. Therefore, an immediate loading protocol may not increase the failure risk of short dental implants.

Comparative Analysis of Peri-Implant Bone Loss in Extra-Short, Short, and Conventional Implants. A 3-Year Retrospective Study

Objective: To evaluate the influence of implant length on marginal bone loss, comparing implants of 4 mm, 6 mm, and >8 mm, supporting two splinted crowns after 36-month functional loading. Materials and Methods: this retrospective clinical trial evaluated the peri-implant behavior of splinted crowns (two per case) on pairs of implants of the same length placed in the posterior maxilla (molar area). Implants were divided into three groups according to length (Group 1: extra-short 4 mm; Group 2: short 6 mm; Group 3: conventional length >8 mm). Marginal bone loss was analyzed using standardized periapical radiographs at the time of loading and 36 months later. Results: 24 patients (19 women and 5 men) were divided into three groups, eight rehabilitations per group, in the position of the maxillary first and second molars. The 48 Straumann^® Standard Plus (Regular Neck (RN)/Wide Neck (WN)) implants were examined after 36 months of functional loading. Statistical analysis found no significant differences in bone loss between the three groups (p = 0.421). No implant suffered biological complications or implant loss. Long implants were associated with less radiographic bone loss. Conclusions: extra-short (4 mm); short (6 mm); and conventional length (>8 mm) implants in the posterior maxilla present similar peri-implant bone loss and 100% survival rates in rehabilitation, by means of two splinted crowns after 36 months of functional loading. Implants placed in posterior positions present better bone loss results than implants placed in anterior positions, regardless of the interproximal area where bone loss is measured. Conventional length (>8 mm) implants show better behavior in terms of distal bone loss than short (6 mm) and extra-short (4 mm) implants.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

This comprehensive review of the 2019 restorative dental literature is offered to inform busy dentists regarding remarkable publications and noteworthy progress made in the profession. Developed by the Scientific Investigation Committee of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to 1 of 8 sections of the report: (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information likely to influence day-to-day dental treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source material when greater detail is desired. As the profession moves toward evidence-based clinical decision-making, an incredible volume of potentially valuable dental literature continues to increase. It is the intention of this review and its authors to provide assistance in negotiating the extensive dental literature published in 2019. It is our hope that readers find this work useful in the clinical management of dental patients.

A clinical study on the 6-year outcomes of immediately loaded three implants for completely edentulous mandibles: "the all-on-3 concept"

The objective of the current study was to demonstrate the 6-year clinical and radiological treatment outcomes of the technique performed by immediately loading of three implants (single straight in the mid-line and two tilted distal implants) for the management of total edentulous mandibles and introduce a simple decision matrix for selection of the most appropriate protocol in cases with insufficient length of the interforaminal area. Re-assessments were performed over a total observation period of 6 years after surgery via measurement of bone resorption around implants, bleeding on probing, plaque accumulation, periodontal probing depth, bite force measurements and oral health impact profile. A total of 29 patients (45% women and 55% men) with a mean age of 65 ± 6 years enrolled in the study. 14 patients received an acryl-based bridge as definitive prosthetic restoration and 15 patients received a ceramic-based restoration. Both during the immediate loading phase and during the 6-year follow-up, there was no implantation loss. Regardless of the implant position, all implants showed continuous bone loss over the observation time. The bone loss around dental implants during observation period was only maximum 1.0 ± 1 mm and it remained well within the limits for 'success' according to the 2007 Pisa consensus (< 2 mm). The plaque index showed no significant fluctuations between the implant positions and the individual examination times. The approach described herein might help the surgeon by avoiding unnecessary loss of bone strength, selecting implant sites, and establishing the biomechanical advantage of increased A-P spread for immediate function.