Immediate and early implant loading protocols: a literature review of clinical studies

The past forty-three years of dental implantology literature. A global mapping and scientometric analysis

PURPOSE

The aim of this research is to make a scientometric analysis of the dental implantology literature and to present the results in a more understandable way to the reader by visualizing them with maps.

METHODS

The dental implantology literature was accessed through the Web of Science database. Scientometric data was obtained with Citespace 6.1 software, co-citation, clustering analysis, citation burst, and mapping analyzes were performed. Scimago Graphica software was used for additional visualizations.

RESULTS

A total of 35,704 articles were included in the analysis. There were 88,616 authors, 72,333 institutes, 142 countries/regions, and 3,265 journals contributing to the dental implantology literature. The United States was first with 7,334 publications and 225,868 citations. The literature between 1980 and 2023 was divided into 19 different clusters, and the literature between 2000 and 2023 was divided into 16 different clusters.

CONCLUSIONS

Key themes in the field include the use of autogenous bone, advancements in implant surface technology, and the use of platform switching and intraoral scanners. Emerging topics of interest include esthetic considerations in the treatment of the anterior region, stress distribution, the use of zirconia, and the impact of implant treatment on oral health-related quality of life. With similar scientometric analysis studies to be done in the future, the progress of the literature can be followed on the basis of evidence.

Patients experience and satisfaction with immediate loading of implant-supported overdentures - A qualitative study

OBJECTIVES

To explore the perspectives and experiences of edentate individuals in regard to the immediate-loading protocol of an implant-supported overdenture.

METHODS

A qualitative approach and interpretive description methodology was used. Seventeen edentate individuals (mean age: 61.9 ± 6.6 years) who received implant-supported overdentures through an immediate-loading protocol participated. Audio-recorded, semi-structured, in-depth interviews, each with a 60-90-minute duration, were conducted by two trained interviewers. The interview guide was developed based on Perneger's Detailed Model. Qualitative data were analyzed using a thematic approach including interview debriefing, transcript coding, data display, inductive thematic analysis, and interpretation.

RESULTS

Three main themes emerged from the interviews: patient awareness and engagement with treatment, experience-shaped expectations, and immediate gratification. All patients expressed satisfaction with the treatment. Providing detailed information, good communication, and accessibility of the dental care provider had a significant impact on patient satisfaction with prosthetic care. Patients highlighted that the high cost of implant therapy was the major barrier to receiving this treatment in the private sector and perceived dental insurance coverage as a facilitator of this process.

CONCLUSIONS

Study findings conclude that patient awareness about immediate-loading protocol improved their treatment engagement, and patient satisfaction with the treatment outcomes was higher than anticipated. The satisfaction was primarily related to prosthesis stability, receiving the prosthesis the same day, and low cost of treatment. Patients' positive experience and satisfaction with the immediate-loading protocol indicate that this treatment modality should be considered in treatment planning for edentate individuals.

CLINICAL SIGNIFICANCE

The perceptions and experiences of edentulous patients gathered in this study highlight their satisfaction with immediate loading for implant-supported overdentures. This therapeutic modality can be considered a viable option in treatment planning for edentulous individuals.

Masticatory performances and maximum occlusal forces of immediate and conventional loaded two-implant supported overdentures retained by magnetic attachments: preliminary study of randomized controlled clinical trial

Background

The appropriate loading protocol to improve masticatory performance (MP) is still unclear in elderly patients and two-implant overdentures (2-IODs) wearers. This study aimed to compare the long-term MP and maximum occlusal force of immediate loading (IL) and conventional loading (CL) of 2-IODs retained by magnetic attachments. Nineteen edentulous patients were randomly assigned to either an IL (n=10) or CL group (n = 9). In the IL group, the implant was loaded on the same day as insertion, whereas it was loaded 3 months after insertion in the CL group. Magnetic attachments were used to retain all overdentures to the implants. MP, measured by a piece of color-changeable chewing gum and a gummy jelly test, and maximum occlusal force, measured using an occlusal force measuring device, were assessed in both groups at baseline and at 3-, 4-, and 5-year follow-ups.

Results

No significant differences were observed in the MP and the maximum occlusal force between the IL and CL groups at any time point. However, a significantly higher MP was observed at the 3-year time point in the IL group (P = 0.036). The maximum occlusal force revealed a significant correlation with MP, both with the color-changeable chewing gum and gummy jelly at 5 years.

Conclusion

After long-term observation, no significant differences in MP and maximum occlusal force were observed between the IL and CL groups. However, compared to pre-implant insertion of the complete denture, the MP in the IL group significantly improved at 3 years. Furthermore, the maximum occlusal force was significantly correlated with MP at 5 years.

Trial registration

UMIN, UMIN000009889. Registered on 28 January 2013.

Can Male Patient's Age Affect the Cortical Bone Thickness of Jawbone for Dental Implant Placement? A Cohort Study

Dental implants are among the most common treatments for missing teeth. The thickness of the crestal cortical bone at the potential dental implant site is a critical factor affecting the success rate of dental implant surgery. However, previous studies have predominantly focused on female patients, who are at a high risk of osteoporosis, for the discussion of bone quality and quantity at the dental implant site. This study aimed to investigate the effect of male patients’ age on the crestal cortical bone of the jaw at the dental implant site by using dental cone-beam computed tomography (CBCT). This study performed dental CBCT on 84 male patients of various ages to obtain tomograms of 288 dental implant sites at the jawbone (41 sites in the anterior maxilla, 95 in the posterior maxilla, 59 in the anterior mandible, and 93 in the posterior mandible) for measuring the cortical bone thickness. A one-way analysis of variance and Scheffe’s test were performed on the measurement results to compare the cortical bone thickness at implant sites in the four jaw areas. The correlation between male patient age and cortical bone thickness at the dental implant site was determined. The four jaw areas in order of the cortical bone thickness were as follows: posterior mandible (1.07 ± 0.44 mm), anterior mandible (0.99 ± 0.30 mm), anterior maxilla (0.82 ± 0.32 mm), and posterior maxilla (0.71 ± 0.27 mm). Apart from dental implant sites in the anterior and posterior mandibles, no significant correlation was observed between male patients’ age and the cortical bone thickness at the dental implant site.

Knowledge, awareness, and perception of dental students, interns, and freshly graduated dentists regarding dental implant complications in Saudi Arabia: a web-based anonymous survey

BACKGROUND

It is necessary for dental students and freshly graduated dentists to apply their education and practice to different clinical and preclinical procedures. The implant success rate and durability are high. Therefore, this study was designed to assess the level of knowledge, awareness and perception of dental students, interns and freshly graduated students regarding dental implant complications in Saudi Arabia.

METHODS

A cross-sectional study design using a web-based method was conducted at different dental institutions in Saudi Arabia from December 2019 to March 2020. Data were collected from all (n = 288) undergraduate students, interns and freshly graduated dentists using a pretested standardized self-administered web-based questionnaire that was prepared and circulated using a template provided by Google Forms (Google, Inc., USA). Descriptive statistics and chi-square tests were performed to analyse the data using SPSS (version 20).

RESULTS

A total of 288 participants completed the questionnaire, with a response rate of 83.4%. Of the total participants, 37.5% showed a good level of knowledge regarding dental implant procedures, and 38.9% showed the same level of knowledge regarding implant complications. The most important cause of complications associated with dental implants was case selection, which accounted for 54.17%. Most participants (58.33%) chose massive bone loss related to implant failure as the most common late dental complication, while 26.39% chose postoperative infection as the most common early dental complication. In addition, 30.56% of the participants selected screw loosening as the most frequent mechanical complication. However, lack of implant primary stability was the most common hard-tissue implant complication. Based on aesthetic and reversible complications, restorations that were too buccal or too palatal and prosthetic-related, respectively, were the least common dental implant complications.

CONCLUSIONS

The level of knowledge among participants regarding dental implant complications differed among the institutions participating in this study. This difference reflects a significant variation that necessitates reviewing and standardizing dental implant curricula among these institutions.

Relationship between Cortical Bone Thickness and Cancellous Bone Density at Dental Implant Sites in the Jawbone

Dental implant surgery is a common treatment for missing teeth. Its survival rate is considerably affected by host bone quality and quantity, which is often assessed prior to surgery through dental cone-beam computed tomography (CBCT). Dental CBCT was used in this study to evaluate dental implant sites for (1) differences in and (2) correlations between cancellous bone density and cortical bone thickness among four regions of the jawbone. In total, 315 dental implant sites (39 in the anterior mandible, 42 in the anterior maxilla, 107 in the posterior mandible, and 127 in the posterior maxilla) were identified in dental CBCT images from 128 patients. All CBCT images were loaded into Mimics 15.0 to measure cancellous bone density (unit: grayscale value (GV) and cortical bone thickness (unit: mm)). Differences among the four regions of the jawbone were evaluated using one-way analysis of variance and Scheffe's posttest. Pearson coefficients for correlations between cancellous bone density and cortical bone thickness were also calculated for the four jawbone regions. The results revealed that the mean cancellous bone density was highest in the anterior mandible (722 ± 227 GV), followed by the anterior maxilla (542 ± 208 GV), posterior mandible (535 ± 206 GV), and posterior maxilla (388 ± 206 GV). Cortical bone thickness was highest in the posterior mandible (1.15 ± 0.42 mm), followed by the anterior mandible (1.01 ± 0.32 mm), anterior maxilla (0.89 ± 0.26 mm), and posterior maxilla (0.72 ± 0.19 mm). In the whole jawbone, a weak correlation (r = 0.133, p = 0.041) was detected between cancellous bone density and cortical bone thickness. Furthermore, except for the anterior maxilla (r = 0.306, p = 0.048), no correlation between the two bone parameters was observed (all p > 0.05). Cancellous bone density and cortical bone thickness varies by implant site in the four regions of the jawbone. The cortical and cancellous bone of a jawbone dental implant site should be evaluated individually before surgery.

Crestal Bone Changes and Patient Satisfaction with Single Implant-Retained Mandibular Overdentures with Dalla Bona and Locator Attachments with Immediate Loading Protocols. A Randomized Controlled Clinical Study

PURPOSE

There is no enough evidence present on the success of single implant-retained mandibular overdentures (SIMO) with Dalla Bona and Locator attachments. This study aims to compare crestal bone loss and patient satisfaction with SIMO with Dalla Bona and Locator attachment following immediate loading protocols.

MATERIAL AND METHODS

Twelve patients included in Group 1 received immediate SIMO with Dalla Bona attachments, and another twelve patients in Group 2 received immediate SIMO with Locator attachments in the mid symphyseal region. The follow-up was scheduled at 6 and 12 months after implant placement. The patient satisfaction with the denture was evaluated with the visual analog scale (VAS) score. The data obtained were statistically analyzed with the independent student t-test for intergroup comparison and repeated measures of ANOVA followed by Bonferroni's Post hoc analysis for intragroup comparison of mean crestal bone loss at a different time interval.

RESULTS

Ten patients each in both the groups were available for follow-up. Crestal bone loss at 6 months follow-up for Dalla Bona group was 0.42 ± 0.10 mm on the mesial side and 0.43 ± 0.14 mm on the distal side and at 1 year 1.54 ± 0.16 mm on the mesial side and 1.66 ± 0.13 mm on the distal side. The mean crestal bone loss at 6 months follow-up for Locator group was 0.48 ± 0.16 mm on the mesial side and 0.45 ± 0.11 mm on the distal side and at 1 year was 1.71 ± 0.22 mm on mesial side and 1.74 ± 0.28 mm on the distal side. There was difference in bone loss at 6 months (mesial: 0.06 mm, p = 0.327; distal:0.02 mm; p = 0.726) and at 1 year (mesial: 0.17 mm, p = 0.063; distal: 0.08 mm; p = 0.423) in between two groups but the difference was statistically insignificant. There was a significant difference found in the VAS score for patient satisfaction with SIMO with Dalla Bona attachments and Locator attachments at 6 months (54.2 vs. 51.8, p = 0.005) and 1 year (60.6 vs. 55.2, p = 0.005).

CONCLUSIONS

Patient satisfaction with SIMO with Dalla Bona attachments was higher during the follow-up. SIMO with Dalla Bona attachments had less crestal bone loss and less prosthetic complications when compared to Locator attachments, although the difference in the bone loss was statistically insignificant.

Influence of Resonance Frequency Analysis (RFA) Measurements for Successful Osseointegration of Dental Implants During the Healing Period and Its Impact on Implant Assessed by Osstell Mentor Device

AIM

This study aimed to investigate and assess primary and secondary dental implant stability during the osseointegration period.

METHODS

A total of 77 implants were placed in 42 patients with 26 males and 16 females. The study was conducted by comparing the resonance frequency analysis (RFA) values of the implants inserted in the lower jaw. RFA was done immediately after implant insertion and after 12 weeks. Results were statistically evaluated using SPSS Statistics for Windows, Version 7.1. Level of significance was set at P < 0.05.

RESULTS

Significant differences were detected between the primary and secondary stability values, respectively. Maximum RFA value of 88 and the minimum value of 52 were observed. Stability values increased during the following three months, and all implants were successfully integrated without complication.

CONCLUSION

Our results indicate and suggest that there is a strong linear correlation between implant stability and ISQ values that can be directly estimated by the RFA, especially in the posterior edentulous mandible. Osstell implant device could represent a useful tool which can be used to identify the risk for implant failure.

Impact of immediately loaded implant-supported maxillary full-arch dental prostheses: a systematic review

OBJECTIVE

The immediate loading of implant-assisted fixed prostheses in edentulous maxillae may achieve favorable success rates with reduced treatment time. An evidence summary of clinical trials is key to recommend loading protocols in these cases.

OBJECTIVES

To compare immediately loaded, fully implant-supported complete dentures to early and conventional/delayed loading in the edentulous maxillae of adult patients by a systematic review of controlled clinical trials (CCT).

METHODOLOGY

CCTs reports were identified up to January 17, 2019 from Cochrane Oral Health Group's Trial register, Cochrane Central Register of controlled trials (CENTRAL), MEDLINE (Ovid), BIOSIS, EMBASE, CINAHL, Web of Science, and DARE. Two independent reviewers screened titles/abstracts and confirmed inclusion using full texts. Data were extracted and quality assessed (Cochrane Risk of Bias tool) independently and in duplicate. Study heterogeneity prevented pooling by meta-analysis.

RESULTS

Out of 1,052 candidate studies, four CCTs were included. Two trials had patient satisfaction as an outcome: (1) A randomized trial compared immediately and early loaded fixed dentures and found more satisfaction with the first after 12 months; (2) A non-randomized study found better satisfaction with immediate fixed dentures compared to conventional loading after 3 months (no more at 12 months). Regarding implant success and prosthetic complications, three trials did not report significant differences comparing immediate loading to other protocols.

CONCLUSIONS

This review found weak evidence of differences between immediate load and other loading regimens, regarding patient satisfaction and maintenance events/adversities. The potential of immediate loading for favorable results in edentulous maxillae reinforces the need for well-designed RCTs, for solid clinical guidelines. Registration number CRD42018071316 (PROSPERO database).

Immediate Loading of Unsplinted Implant Retained Mandibular Overdenture: A Randomized Controlled Clinical Study

This clinical study aimed to clinically and radiographically compare the implant survival rate and peri-implant tissue response between immediate and delayed loading protocols for unsplinted implant retained mandibular overdentures. Twenty patients were enrolled to participate in this study. Each subject was randomly assigned to 1 of 2 treatment groups: test group patients' implants (n = 10), which were immediately loaded, and control group patients' implants (n = 10), which were conventionally loaded. Locator abutments were torqued to 15 Ncm at delivery. Attachments were picked up intraorally immediately after implant placement for the test group and at 3 months for the control group, and 3-lb retention inserts were placed. Marginal bone levels based on cone beam computed tomography fixed reference points were recorded at baseline and 12 months. Modified plaque index, gingival index, and implant stability quotients were recorded at baseline, 3 months, and 12 months. After 12 months, implant survival rate was 100% in both groups. Marginal bone levels, keratinized mucosa, modified plaque index, and gingival index were significantly different among the groups at 3- and 12-month intervals, whereas no significant differences were found in implant stability quotients between the groups. The fact that implant survival rate was 100% in both treatment groups suggests that, within the limitations of this study, immediate loading protocol for unsplinted implant retained mandibular complete overdenture is as predictable, safe, and successful as the delayed loading protocol. Implementing the immediate loading protocol for mandibular implant retained overdentures could shorten treatment time, which could lead to better patient's satisfaction.

Marginal Bone Loss Around One-Piece Implants: A 10-Year Radiological and Clinical Follow-up Evaluation

PURPOSE

This study was conducted to investigate one-piece narrow-diameter implants installed in maxillary lateral and mandibular incisor sites using immediate nonfunctional loading.

MATERIALS AND METHODS

In this 10-year clinical trial study, 42 narrow-diameter (3.0-mm) one-piece implants for 35 patients were inserted. Clinical and radiographic measurements were recorded in 10 years and analyzed statistically using t test.

RESULTS

A total of 26 patients (20 females and 6 males) with 30 implants were available for the 10-year follow-up. The 10-year implant survival rate was 100%. A statistically significant mean marginal bone loss was observed between 12 months and 10 years (0.18 ± 0.29 mm). The mean pocket depth increase was statistically significant (0.68 ± 0.83 mm). No bleeding on probing was observed around 90% of the implants. Full-mouth plaque index was registered at 20% of the implants.

CONCLUSION

The results obtained in this analysis suggest that modest marginal bone loss was observed around the implants. One-piece narrow-diameter implants (Maximus 3.0; BioHorizons) can predictably restore missing maxillary lateral incisors and mandibular incisors in cases of careful patient selection.

Retrospective Study of Tapered One-Piece Implants Placed Over a Ten-Year Period in a Single Private Practice

Today, clinicians have a variety of treatment modalities available to address the increasing number of implant procedures performed each year. Single-stage implant surgery is now commonly used in implant dentistry. With patients' demands for immediate restoration, the utilization of 1-piece implants is gaining acceptance. This article reports the results of tapered 1-piece implants (Zimmer Biomet) placed in a single practice over a 10-year period. A total of 33 1-piece dental implants were placed in 24 patients and provisionally restored out of occlusion at the time of surgery. All 33 implants were definitively restored with ceramometal crowns after 3 months of provisionalization. Implant survival and success rates were 100% after 2.6–10 years of follow-up. Only 1 minor complication of crestal bone remodeling occurred among the 33 implants placed. Adequately stabilized tapered 1-piece implants can be successfully restored out of occlusion at the time of implant placement and definitively loaded in occlusion 3 months without adversely affecting function or esthetics. Additional long-term controlled studies are recommended to further understand these findings.

Analysis of crestal bone loss around single piece ball attachment implant placed bilaterally in canine region and wear of O-ring in implant supported overdenture: Three year follow-up

BACKGROUND

Single piece implant in fixed prosthesis is widely been evaluated, however, long term evaluation of crestal bone loss and the wear of O-ring in single piece ball attachment implant supported overdenture is yet to be evaluated PURPOSE: The present article evaluates the crestal bone loss around single piece ball attachment implants placed bilaterally in the canine region and the wear of O-ring in implant supported overdenture over a period of three years.

MATERIALS AND METHODS

Twelve completely edentulous patients between the age group of 55-65 years were selected. Two 3.3 mm × 13 mm myriad snap fit implants were placed in the mandibular interforaminal region. All the implants were conventionally loaded at three months after surgical placement. Intra-oral periapical radiographs were made and crestal bone loss was measured at the end of one year and three years. The elasticity and wear of O-Ring was assessed after three years of usage.

RESULTS

The crestal bone loss showed no significant difference between the first and third year after implant placement. The mean bone loss at the end of third year was 1.5 mm. Analysis of O-ring for change in the elasticity showed reduction in displacement and a significant increase in maximum displacement and elongation. The area of O-ring and yield stress did not show any changes from the standard value. Compression set damage was observed in the O-ring at the end of three years.

CONCLUSIONS

The present study shows that the bilateral single piece implant supported overdenture has a success rate equivalent to the two piece implant supported overdenture and is a viable treatment option.

Bone remodeling and mechanobiology around implants: Insights from small animal imaging

Anchorage of orthopedic implants depends on the interfacial bonding between the implant and the host bone as well as on the mass and microstructure of peri-implant bone, with all these factors being continuously regulated by the biological process of bone (re)modeling. In osteoporotic bone, implant integration may be jeopardized not only by lower peri-implant bone quality but also by reduced intrinsic regeneration ability. The first aim of this review is to provide a critical overview of the influence of osteoporosis on bone regeneration post-implantation. Mechanical stimulation can trigger bone formation and inhibit bone resorption; thus, judicious administration of mechanical loading can be used as an effective non-pharmacological treatment to enhance implant anchorage. Our second aim is to report recent achievements on the application of external mechanical stimulation to improve the quantity of peri-implant bone. The review focuses on peri-implant bone changes in osteoporotic conditions and following mechanical loading, prevalently using small animals and in vivo monitoring approaches. We intend to demonstrate the necessity to reveal new biological information on peri-implant bone mechanobiology to better target implant anchorage and fracture fixation in osteoporotic conditions. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:584-593, 2018.

Peri-Implant Bone Loss of External Hexagon and Morse Taper in Patients Wearing Immediately Loaded Overdentures

The aim of this study was to evaluate the peri-implant bone loss of External Hexagon (EH) and Morse Taper (MT) implants in patients wearing immediately loaded mandibular overdentures during a 1-year follow-up. This is a non-randomized controlled clinical trial including 18 MT and 22 EH implants. Periapical radiographs were taken after overdentures insertion and following 1 year. The peri-implant bone loss was assessed through digitalization and analysis of the radiographs in the software Corel DRAW X7. For this, measurement from implant platform to residual ridge at mesial and distal surfaces of each implant was conducted. The results showed high success rate in the groups EH (100%) and MT (94.4%). For peri-implant bone levels, it was found significant difference between the groups (p=0.032) and greater bone loss was observed in the group EH. In general, bone loss was 0.85mm (±0.82) for EH and 0.10mm (±1.0) for MT. It was concluded that greater bone loss occurred in the group EH in comparison to the group MT after a 1-year follow-up.

Success rate and strength of osseointegration of immediately loaded UV-photofunctionalized implants in a rat model

STATEMENT OF PROBLEM

Despite its clinical benefits, the immediate loading protocol might have a higher risk of implant failure than the regular protocol. Ultraviolet (UV) photofunctionalization is a novel surface enhancement technique for dental implants. However, the effect of photofunctionalization under loading conditions is unclear.

PURPOSE

The purpose of this animal study was to evaluate the effect of photofunctionalization on the biomechanical quality and strength of osseointegration under loaded conditions in a rat model.

MATERIAL AND METHODS

Untreated and photofunctionalized, acid-etched titanium implants were placed into rat femurs. The implants were immediately loaded with 0.46 N of constant lateral force. The implant positions were evaluated after 2 weeks of healing. The strength of osseointegration was evaluated by measuring the bone-implant interfacial breakdown point during biomechanical push-in testing.

RESULTS

Photofunctionalization induced hydrophilic surfaces on the implants. Osseointegration was successful in 28.6% of untreated implants and 100% of photofunctionalized implants. The strength of osseointegration in successful implants was 2.4 times higher in photofunctionalized implants than in untreated implants. The degree of tilt of untreated implants toward the origin of force was twice that of photofunctionalized implants.

CONCLUSIONS

Within the limit of an animal model, photofunctionalization significantly increased the success of osseointegration and prevented implant tilt. Even for the implants that underwent successful osseointegration, the strength of osseointegration was significantly higher for photofunctionalized implants than for untreated implants. Further experiments are warranted to determine the effectiveness of photofunctionalization on immediately loaded dental implants.

Immediate dental implant placement with immediate loading following extraction of natural teeth

The loss of tooth in the esthetic area is often a traumatic experience for the patient. Patients may suffer real or perceived detrimental effects following the loss of one or more teeth. Dental implant offers the most cost-effective and long-term solution for replacement of missing teeth with high average life expectancy, providing the patient with the best sense of security and well-being. Recently, immediate implant placement after extraction of tooth with early loading has become more common. The advantages of this procedure include fewer surgical interventions, reduction in overall treatment time, reduced soft and hard tissue loss, and psychological satisfaction to the patient. This case report describes the procedure for immediate implant placement with immediate loading of implants by provisional restorations.

Long-Term Outcomes of Early Loading of Straumann Implant-Supported Fixed Segmented Bridgeworks in Edentulous Maxillae: A 10-Year Prospective Study

BACKGROUND

There have been few studies investigating the long-term outcome of early-loaded implants with segmented bridgeworks on fully edentulous maxillae.

PURPOSE

To evaluate the long-term predictability of early-loaded Straumann implant-supported fixed segmented bridgeworks in edentulous maxillae.

MATERIAL AND METHODS

Ninety-one implants were placed in 12 patients with edentulous maxillae. After a healing period of 6 weeks, the abutments were tightened followed by cementing of fixed full-arch prostheses. The patients were recalled after 1, 3, 5, and 10 years of loading for clinical evaluation. Implant success rate, peri-implant soft tissue condition, technical complications, marginal bone loss and patients' satisfaction was assessed.

RESULTS

Eleven of the 12 patients attended the 10-year follow-up. Two implants were lost. The implant success rate was 97.6% at implant level and 81.8% at patient level. The mean marginal bone loss was found to be 0.41 ± 0.55mm, 0.53 ± 0.43mm, 0.68 ± 0.76 mm and 1.01 ± 0.85 mm at the 1, 3, 5, and 10-year follow-up respectively. None of the 11 patients showed a modified plaque index (mPLI) or modified bleeding index (mBI) of 3. Only one patient was found to have pocket probing depth (PPD) exceeding 3 mm. Peri-implantitis was found around one of the implants in a patient after 4 years of loading. The success rate of prostheses was 55.3% at prosthesis level and 27.3% at patient level. The most common technical complication of the prostheses was chipping of the ceramic veneer. Damaged veneers were observed in five patients. Other complications were loss of retention and abutment loosening.

CONCLUSION

Early loading of Straumann SLA implants for support of full-arch segmented bridgeworks represents a viable therapy for the fully edentulous maxillae in the long term. High success rate of implants, acceptable peri-implant soft tissue condition and excellent patient satisfaction can be achieved, while technical complications of prostheses are common.

Clinical and Radiographic Evaluation of Immediate Loaded Dental Implants With Local Application of Melatonin: A Preliminary Randomized Controlled Clinical Trial

Immediate loading of dental implants in situations where low bone density exist, such as the posterior maxillary region, became possible recently after the introduction of biomimetic agents. This 1-year preliminary clinical trial was carried out to clinically and radiographically evaluate immediate-loaded 1-piece implants with local application of melatonin in the osteotomy site as a biomimetic material. 14 patients with missing maxillary premolars were randomized to receive 14 implants of 1-piece type that were subjected to immediate loading after 2 weeks of initial placement. Group I included 7 implants with acid-etched surface while group II included 7 implants with acid-etched surface combined with local application of melatonin gel at the osteotomy site. Patients were recalled for follow up at 1, 3, 6, and 12 months after loading. All implants were considered successful after 12 months of follow-up. Significant difference (P &lt; 0.05) was found between both groups at 1 month of implant loading when considering the implant stability. At 1 and 3 months there were significant differences in the marginal bone level between the 2 groups. These results suggest that the local application of melatonin at the osteotomy site is associated with good stability and minimal bone resorption. However, more studies for longer follow-up periods are required to confirm the effect of melatonin hormone on osseointegration of dental implants.

Comparative study of immediate functional loading and immediate non-functional loading of monocortical implants

BACKGROUND

Attempts to shorten the overall length of treatment have focused on immediate loading, subsequent to implant placement. Prosthetic rehabilitation immediately after implant placement can be either functional or non-functional in nature. There is paucity of literature on the comparative evaluation of immediate functional and immediate non-functional loading of implants. This in-vivo study was undertaken to comparatively evaluate Immediate Functional Loading and Immediate Non-Functional Loading of monocortical implants with a follow-up period of 18 months.

METHODS

50 partially edentulous cases were selected for the study. The cases were divided into two groups. In first group (Group-1), 25 implants were subjected to immediate functional loading. In second group (Group-2), 25 implants were subjected to immediate non-functional loading. The crestal bone loss, clinical stability and degree of osseointegration of these two groups were comparatively evaluated.

RESULTS

The crestal bone loss in both groups was within acceptable limits. The implant stability, which is a reflection of the status of bone-to-implant interface, was comparable in both the groups at different time intervals. Although, the ISQ values in Group-2 were slightly higher than those in Group-1, the results were not statistically significant. Radiodensity indicating degree of osseointegration at different time intervals in both groups was also comparable.

CONCLUSION

Both the IFL and INFL protocols can be undertaken satisfactorily in rehabilitation using endosseous implants; however, the main factors for success in IFL and INFL are case selection, meticulous treatment planning and the precision of technique.

Analysis of the Factors Affecting Surgical Success of Implants Placed in Iranian Warfare Victims

OBJECTIVE

The aim was to evaluate the survival time and success rates of dental implants in warfare victims and factors that affect implant success.

SUBJECTS AND METHODS

This retrospective study involved 250 Iranian warfare victims who received dental implants from 2003 to 2013. Patients' demographic characteristics, as well as the brand, diameter, length, location and failure rate of the implants were retrieved from patients' dental records and radiographs. The associations between these data and the survival rate were analyzed. Statistical analysis was carried out with χ2 and log-rank tests.

RESULTS

Overall, out of the 1,533 dental implants, 61 (4%) failed. The maxillary canine area had the highest failure rate [9 of 132 implants (6.8%)], while the mandibular incisor region had the least number of failures [3 of 147 implants (2.0%)] and the longest survival time (approximately 3,182 days). Maxillary canine areas had the shortest survival (about 2,996 days). The longest survival time was observed in implants with 11 mm length (3,179.72 ± 30.139 days) and 3.75-4 mm diameter (3,131.161 ± 35.96 days), and the shortest survival was found in implants with 11.5 mm length (2,317.79 ± 18.71 days) and 6.5 mm diameter (2,241.45 ± 182.21 days). Moreover, implants with 10 mm length (10.7%) and 5.5-6 mm diameter (22.2%) had the highest failure rate; however, the least failure rate occurred when the implants were 11.5 mm in length (1.9%) and 3-3.5 mm in diameter (3.1%).

CONCLUSIONS

The brand, length and diameter of implants affected the survival time, failure rate and time to failure. The location of the implant was not statistically significant regarding the mentioned factors, although it has clinical significance.

A clinico radiographic study of immediate loading implants in rehabilitation of mandibular ridges

BACKGROUND

Numerous studies regarding the immediate loading of splinted implants retaining/supporting mandibular dentures have reported promising results, but studies comparing splinted and unsplinted attachments for supporting overdentures with immediate loading are limited. Scientific literature is sparse comparing various attachment systems and patient satisfaction in response to immediately loaded implant supported overdentures.

METHODS

A total of 30 completely edentulous patients male or female, in the age group of 54-78 years (mean age 65 years), wearing conventional complete dentures were selected and randomly divided in to two groups. A total of 60 implants were placed in the interforaminal area of the mental symphysis (two implants per patients) in 30 patients. Two types of attachment systems namely Ball for group-A and Bar for group-B were used and immediate loading done. Implants were evaluated clinically and radiographically at baseline, 1 month, 3 months, 6 months and 9 months. All clinical and radiographic parameters were subjected to statistical analysis.

RESULT

The implant survival rate for group-A (ball attachment) was 93.3% and implant survival rate for group-B (bar attachment) was 93.3%. The overall implant survival rate was not dependent on the attachment system. There was no significant difference in the crestal bone loss in mesial, and distal side in implants with respect to ball and bar attachment for different period of observation (F = 0.25; P = 0.910; F = 0.07; P = 0.992 respectively).

CONCLUSION

Overdenture supported by two implants should be the minimum gold standard in the rehabilitation of completely edentulous patients.

Locators versus magnetic attachment effect on peri-implant tissue health of immediate loaded two implants retaining a mandibular overdenture: a 1-year randomised trial

This study aimed to evaluate peri-implant tissue health of immediate loaded two implants retaining a mandibular overdenture with either magnetic or locator attachment. Thirty two completely edentulous patients (20 males/12 females) were randomly assigned into two groups. Each patient received two implants in the canine area of the mandible using flapless surgical technique. Mandibular overdentures were immediately connected to the implants with either magnetic (group I, GI) or locator (group II, GII) attachments. Peri-implant tissue health was evaluated clinically in terms of plaque scores (PI), bleeding scores (BI), probing depth (PD), implant stability (ISQ) and interleukin-1-β (IL-1b) concentrations in peri-implant sulcular fluid. PI, BI and PD were measured at mesial, distal, buccal and lingual surfaces of each implant. Radiographic evaluation was performed in terms of vertical (VBL) and horizontal (HBLO) alveolar bone loss. Evaluations were performed 2 weeks (T0), 6 months (T1) and 12 months (T2) after overdenture insertion. Plague scores, PD, IL-1b, VBL and HBLO increased significantly with time. ISQ decreased significantly with time. BI showed no significant differences between observation times. GI recorded significant higher PI, ISQ and IL-1b at T2 compared to GII. GII recorded significant higher VBL than GI at T2 only. For HBLO, no significant differences between groups were noted. VBL and HBLO showed a significant positive correlation with PD. Locator attachments for immediate loaded implants retaining mandibular overdentures are associated with decreased plaque accumulation, decreased implant stability, decreased interleukin-1β concentration in peri-implant crevicular fluid and increased per-implant vertical bone loss compared to magnetic attachments after 1 year.

Comparison of marginal bone loss and patient satisfaction in single and double-implant assisted mandibular overdenture by immediate loading

PURPOSE

The purpose of this study was to compare the coronal bone level and patient satisfaction in 1-implant and 2-implant assisted mandibular overdentures.

MATERIALS AND METHODS

Twenty patients who had maladaptive mandibular dentures were treated in this study. Patients were randomly divided into two groups. The first group received 1 implant (Simple line II, Implantium, South Korea) in their mandibular midline and the second group received 2 implants in their B and D regions (according to Misch's category). If the primary stability of each implant was at least 60 ISQ, ball attachment was placed and denture relined with soft liner. After 6 weeks, retentive cap incorporated with hard acrylic resin. In the 6 and 12 months recalls, periapical digital radiograph were made and visual analogue scale questionnaires were used to record patient satisfaction. The Friedman test was done for comparing the presurgical and postsurgical parameters in each group and the U-Mann Whitney test (P<.05) was done for comparison of post-treatment results between the two groups.

RESULTS

All implants achieved sufficient primary stability to be immediately loaded. Patient satisfaction was high, and there were no significant differences between two groups (P>.05). In addition, mean marginal bone loss was 0.6 ± 0.67 mm in the first group and 0.6 ± 0.51 mm in the second group, after 12 month. Mean marginal bone loss showed no significant differences between two groups.

CONCLUSION

This preliminary one-year result indicated that mandibular overdentures anchored to a single implant can be a safe and cost-effective method as a starting step for implant-overdenture treatment.

Patients' expectations, satisfaction, and quality of life with immediate loading protocol

OBJECTIVES

To examine patients' expectations, the level of satisfaction, and the oral health-related quality of life (OHRQoL) with regard to the implants' immediate loading protocol (ILP) in edentate individuals.

METHODS

This pilot trial used a pre-post design to assess patient-centered outcomes in 18 edentate individuals (mean age 62.4 ± 7.7 years) who have received a 2-implant (unsplinted) mandibular overdenture through an ILP. Visual analog scales, the McGill denture satisfaction questionnaire, and the oral health impact profile (OHIP-20) questionnaire were used to evaluate patients' expectations, satisfaction, and OHRQoL at baseline, 2 weeks, 1 month, and 4 months after surgery. Personality trait and socio-demographic information were obtained using the revised NEO personality inventory and a self-administered questionnaire, respectively. Non-parametric methods and Brunner-Langer approach were used to analyze the data.

RESULTS

The participants had a wide range of expectations regarding the ILP. Expectations included short-term positive impact on aesthetics (83.3%) and social life (55.7%), as well as negative effects on comfort (5.6%), the ability to chew (11.1%), and the ability to clean the lower denture (11.1%). The ILP satisfied 94.4% of the participants, regardless of socio-demographic and personality profiles. There was a statistically significant improvement in overall satisfaction, comfort, perceived aesthetics, stability of the overdenture, and ability to chew from baseline to 2-week, 1-, and 4-month follow-up (P < 0.001). There was 100% agreement among patients on recommending this procedure to others. There was a statistically significant decrease in the total OHIP scores and all its domains (P < 0.001) from baseline to 2 weeks. These differences remained statistically significant at 4-month follow-up. The ILP improved patients' OHRQoL, regardless of the implant loss, the socio-demographic characteristics, and personality traits.

CONCLUSIONS

The ILP of two unsplinted implants with a mandibular overdenture significantly improved satisfaction and short-term OHRQoL, and appears to meet expectations in edentulous elders. There was 100% agreement among patients on recommending this procedure to others.

Low-magnitude high-frequency loading, by whole-body vibration, accelerates early implant osseointegration in ovariectomized rats

Osteoporosis deteriorates jaw bone quality and may compromise early implant osseointegration and early implant loading. The influence of low-magnitude, high-frequency (LMHF) vibration on peri-implant bone healing and implant integration in osteoporotic bones remains poorly understood. LMHF loading via whole-body vibration (WBV) for 8 weeks has previously been demonstrated to significantly enhance bone-to-implant contact, peri-implant bone fraction and implant mechanical properties in osteoporotic rats. In the present study, LMHF loading by WBV was performed in osteoporotic rats, with a loading duration of 4 weeks during the early stages of bone healing. The results indicated that 4-week LMHF loading by WBV partly reversed the negative effects of osteoporosis and accelerated early peri-implant osseointegration in ovariectomized rats.

Immediate loading implants with mandibular overdenture: a 48-month prospective follow-up study

The aim of this prospective clinical study was to evaluate patient rehabilitation with two immediately loaded implants and bar-retained mandibular overdentures after 48 months of follow-up. Twenty patients were treated with two implants each; of these, 17 patients were re-evaluated for comparison. Gender, age, plaque index, gingival inflammation, keratinized mucosa, probing depth, bleeding, and implant loss data were recorded, and periapical radiographs were obtained for measurement of marginal bone loss. The results were statistically analyzed with one-way analysis of variance (ANOVA) followed by Student's t-test and Pearson's correlation test. To compare the data at baseline and after 48 months, a Wilcoxon Signed Rank Test was performed (α = 0.05). One implant failed (2.9%) during the first year and was replaced. A total of 35 implants were evaluated. Bone loss values were 0.52-2.89 mm (mean, 1.46 mm). Probing depth was 1.75-3.75 mm (mean, 2.22 mm). Correlations were found between bone loss and plaque index and between bone loss and gender, but bone loss did not correlate with gingival inflammation, keratinized mucosa, probing depth, or age. The overall survival rate of the implants was 97.1%. Based on these results, the use of two immediately loaded splinted interforaminal implants to retain an overdenture with a bar attachment is a clinically viable option with a high survival rate.

Space requirement of a prefabricated bar on two interforaminal implants: a prospective clinical study

OBJECTIVES

This clinical study measured the dimensional changes of existing lower complete dentures due to the integration of a prefabricated implant bar. Additionally, the impact of this dimensional change on patient satisfaction and oral function was analyzed.

METHODS

Twenty edentulous patients (10 men/10 women; aged 65.9 ± 11.8 years) received two interforaminal implants. Subsequent to surgery, a chair side adapted, prefabricated bar (SFI Bar(®), C+M, Biel, Switzerland) was inserted, and the matrix was polymerized into the existing lower denture. The change of the denture's lingual dimension was recorded by means of a bicolored, silicone denture duplicate that was sectioned in the oro-vestibular direction in the regions of the symphysis (S) and the implants (I-left, I-right). On the sections, the dimensional increase was measured using a light microscope. Six months after bar insertion, patients answered a standardized questionnaire.

RESULTS

All dentures exhibited increased lingual volume, more extensively at S than at I (P = 0.001). At S, the median diagonal size of the denture was doubled (+4.33 mm), and at I, the median increase was 50% (I-left/-right = +2.66/+2.62 mm). The original denture size influenced the volume increase (P = 0.024): smaller dentures led to a larger increase. The amount of denture increase did not have negative impact on either self-perceived oral function or patient satisfaction. Approximately, 95% of the patients were satisfied with the treatment results.

CONCLUSIONS

The lingual size of a lower denture was enlarged by the integration of a prefabricated bar without any negative side effects. Thus, this attachment system is suitable to convert an existing full denture into an implant-supported overdenture.

Influence of thread pitch, helix angle, and compactness on micromotion of immediately loaded implants in three types of bone quality: a three-dimensional finite element analysis

This study investigated the influence of thread pitch, helix angle, and compactness on micromotion in immediately loaded implants in bone of varying density (D2, D3, and D4). Five models of the three-dimensional finite element (0.8 mm pitch, 1.6 mm pitch, 2.4 mm pitch, double-threaded, and triple-threaded implants) in three types of bone were created using Pro/E, Hypermesh, and ABAQUS software. The study had three groups: Group 1, different pitches (Pitch Group); Group 2, same compactness but different helix angles (Angle Group); and Group 3, same helix angle but different compactness (Compact Group). Implant micromotion was assessed as the comprehensive relative displacement. We found that vertical relative displacement was affected by thread pitch, helix angle, and compactness. Under vertical loading, displacement was positively correlated with thread pitch and helix angle but negatively with compactness. Under horizontal loading in D2, the influence of pitch, helix angle, and compactness on implant stability was limited; however, in D3 and D4, the influence of pitch, helix angle, and compactness on implant stability is increased. The additional evidence was provided that trabecular bone density has less effect on implant micromotion than cortical bone thickness. Bone type amplifies the influence of thread pattern on displacement.

Marginal bone resorption around immediate and delayed loaded implants supporting a locator-retained mandibular overdenture. A 1-year randomised controlled trial

The aim of this 1-year study was to evaluate and compare crestal bone loss and clinical outcomes of immediate and delayed loaded implants supporting mandibular overdentures with Locator attachments. In a randomised controlled clinical trial, 36 completely edentulous patients (mean age 59.6 years) who desired to improve the stability of their mandibular dentures 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 (delayed loading group, G1) or the same day (immediate loading group, G2) after implant placement. Locator attachments were used to retain all overdentures to the implants. Peri-implant vertical (VBL) and horizontal (HBLO) bone losses and clinical parameters [plaque scores (PI), gingival scores (GI), probing depths (PD) and implant stability (ISQ)] were assessed at time of overdenture insertion (T0), 6 months (T6) and 12 months (T12) after overdenture insertion. After 12 months of overdenture insertion, two implants (5.5%) failed in G2. Vertical bone loss was significantly higher in G2 compared with G1, while HBLO demonstrated insignificant differences between groups. All clinical parameters (PI, GI, PD and ISQ) did not differ significantly between groups. Vertical bone loss was significantly correlated with PD and HBLO. Immediately loaded two implants supporting a Locator-retained mandibular overdenture are associated with more vertical bone resorption when compared to delayed loaded implants after 1 year. Clinical outcomes do not differ significantly between loading protocols.

Immediate loading of one-piece implants in conjunction with a modified technique of inferior alveolar nerve lateralization: 10 years follow-up

This report describes a treatment modification for a patient presented with severely resorbed bilateral edentulous posterior mandible and mobility of the anterior teeth. There was less than 8 mm of bone between the crest of the alveolar ridge and the mandibular canal as revealed by radiographic examination. A modified technique for inferior alveolar nerve lateralization (IANL) in conjunction with ridge expansion was performed using threaded bone expanders, which allowed for better primary stability and placing longer implants. A total of four postextraction implants were in the anterior region of the mandible. The mandible received a total of nine one-piece implants to allow for immediate nonfunctional loading. The definitive ceramometallic prosthesis was delivered 3 months postoperatively. The 10 years clinical and radiographic assessment showed minimal bone resorption around osseointegrated implants. One-piece implants showed great success rate and minimal bone resorption following the modified technique of IANL and immediate implantation.

Immediately loaded implants in a patient with involuntary mandibular movements: a clinical report

Immediately loaded implant prostheses have been used to successfully rehabilitate completely edentulous arches. Risk factors for successful treatment have not included involuntary mandibular movements. The treatment was completed on a patient with a history of neuroleptic medications who had remaining mandibular teeth extracted and then developed involuntary mandibular movements. The patient was dissatisfied with a mandibular removable prosthesis and wanted a fixed prosthesis. The immediate implant loading of a complete arch fixed prosthesis was delivered, and the patient lost 3 of the 6 implants. The patient continued to have problems with her definitive prostheses as the symptoms of her involuntary mandibular movements worsened.

A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years

OBJECTIVES

The objective of this systematic review was to assess the 5- and 10-year survival of implant-supported fixed dental prostheses (FDPs) and to describe the incidence of biological and technical complications.

METHODS

An electronic Medline search complemented by manual searching was conducted to identify prospective and retrospective cohort studies and case series on FDPs with a mean follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit. Failure and complication rates were analyzed using standard and random-effects Poisson regression models to obtain summary estimates of 5-year and 10-year survival and complication rates.

RESULTS

The updated search provided 979 titles and 257 abstracts. Full-text analysis was performed for 90 articles resulting in a total 32 studies that met the inclusion criteria. Meta-analysis of these studies indicated an estimated survival of implants supporting FDPs of 95.6% after 5 years and 93.1% after 10 years. When machined surface implants were excluded from the analysis and only rough surface implants included, the survival rate increased to 97.2% after 5 years. The survival rate of implant-supported FDPs was 95.4% after 5 years and 80.1% after 10 years of function. When the analysis was done exclusively for metal-ceramic FDPs, hence the old gold-acrylic FDPs were excluded, the survival rate increased significantly. The survival rate of metal-ceramic implant-supported FDPs was 96.4% after 5 years and 93.9% after 10 years. Only 66.4% of the patients were free of any complications after 5 years. The most frequent complications over the 5-year observation period were fractures of the veneering material (13.5%), peri-implantitis and soft tissue complications (8.5%), loss of access hole restoration (5.4%), abutment or screw loosening (5.3%), and loss of retention of cemented FDPs (4.7%).

CONCLUSION

It may be concluded that implant-supported fixed dental prostheses (FDPs) are a safe and predictable treatment method with high survival rates. However, biological and technical complications were frequent (33.6%). To minimize the incidence of complications, dental professionals should make great effort in choosing reliable components and materials for implant-supported FDPs and the patients should be placed in well-structured maintenance system after treatment.

A Retrospective Study on Immediate Placement of Neoss Implants with Early Loading of Full-Arch Bridges

BACKGROUND

Full-arch clearances of compromised teeth and placement of implant-supported prostheses is one solution for the prosthetic rehabilitation of partially dentate patients.

PURPOSE

To retrospectively evaluate treatment outcomes after full clearance, immediate placement, and early loading of full-arch fixed bridges.

MATERIALS AND METHODS

Fifty-five patients subjected to full clearance and placement of 284 Neoss implants (Bimodal™ and Proactive™, Neoss Ltd, Harrogate, UK) in 29 edentulous maxillae and 26 mandibles for early loading (1 to 3 days) of a provisional full-arch bridge were retrospectively evaluated after 1 to 6 years of loading. Osstell™ measurements (Osstell AB, Göteborg, Sweden) were taken at placement and after 3 to 9 months when the provisional bridge was replaced with a permanent one. Marginal bone levels were measured in intraoral radiographs.

RESULTS

All patients (100%) wore a fixed bridge at the time of finalizing the study. A total of 18 failures (6.3%) were encountered during the follow-up, giving an overall cumulative survival rate of 93.7%. All failures occurred in the maxilla (10.6%), and no implants were lost in the mandible. More Bimodal™ (9.0%) than Proactive™ (4.1%) implants failed. Failing implants showed a significantly lower mean primary stability than successful ones (p = .015). Failed cases showed a significantly lower average ISQ for all implants (p = .015) and a marked decrease to the second registration, while successful cases showed and maintained high ISQs. The average bone loss after 1 year was 0.8 ± 0.5 mm.

CONCLUSIONS

Full-arch clearance of severely diseased teeth followed by immediate placement of Neoss implants, early loading with provisional full-arch bridges, and subsequent permanent bridges is a possible treatment modality for partially dentate patients. Caution with this approach is recommended for the maxilla, as opposed to the mandible.

Geriatric slim implants for complete denture wearers: clinical aspects and perspectives

Background

Advances made in prevention have helped postpone complete edentulism in older patients. However, in the elderly, the physiological state reduces patients’ ability to adapt to oral rehabilitation and degrades the patient’s oral condition. Consequently, elderly edentulous subjects avoid many types of foods, which can lead to substantial nutritional consequences. Complete dentures retained by implants are, currently, the treatment of reference in prosthodontic mandibular rehabilitation. Indeed, the mandibular symphysis generally tolerates implantation, even when the mandible is strongly resorbed. However, in the elderly, implant rehabilitation is compromised by the complexity of the surgical protocol and possible postoperative complications. In this context, the use of geriatric “slim implants” (GSI) offers an interesting alternative.

Methods

In the present study, the surgical and prosthetic procedures for the use of GSI in a French dental hospital are presented. The objective was the stabilization of a complete mandibular denture in an elderly person, with the immediate implantation of four GSI.

Results

The operating procedure was found to be less invasive, less expensive, simpler, and more efficient than the conventional procedure.

Conclusion

The result strongly suggests that this protocol could be used systematically to treat complete edentulism in very elderly patients. Long-term monitoring and the evaluation of the reliability of this type of rehabilitation should be undertaken.