Immediate Loading of Implant Overdentures Using Modified Loading Protocol

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.

Implant survival in 1- versus 2-implant mandibular overdentures: a systematic review and meta-analysis

OBJECTIVE

This systematic review was performed to compare the survival of 1- vs. 2-implant overdentures (IODs) in the edentulous mandible.

MATERIALS AND METHODS

Manual and electronic database (PubMed, EMBASE and CENTRAL) searches were performed to identify scientific articles, published in English, reporting on mandibular IODs utilizing unsplinted attachments. Studies were included if they were prospective human studies reporting on two-piece microrough surface implants with a diameter ≥3 mm. Data were extracted by two independent investigators, and an overall inter-investigator kappa score was calculated. A meta-analysis was performed on the included comparative studies.

RESULTS

The search shortlisted 30 prospective studies for data extraction and statistical analysis. The included studies comprised of only two randomized controlled trials (RCTs) comparing 1- vs. 2-IODs, and a further 28 prospective studies. The kappa score calculated was between 0.86 and 1 for the various parameters. One RCT favored 1-IODs (RD: 0.08, 95% CI: 0.01, 0.14) while the other favored 2-IODs (RD:-0.04, 95% CI: -0.27, 0.19). However, the overall random effects model did not reveal a significant risk difference (RD) for implant failure between the two interventions (I(2) = 36.6%, P = 0.209; RD: 0.05, 95% CI: -0.07, 0.18).

CONCLUSIONS

The results of this meta-analysis conclude that the postloading implant survival of 1-IODs is not significantly different from 2-IODs. However, the existing scientific evidence in the literature in terms of prospective comparative studies is scarce. Hence, before recommending the 1-IOD as a treatment modality, long-term observations are needed and a larger range of functional, prosthodontic, and patient-centered outcome measures should be considered.

Immediate Implant Placement in a Patient With Osteoporosis Undergoing Bisphosphonate Therapy: 1-Year Preliminary Prospective Study

The purposes of this preliminary study are to assess the risk of developing bisphosphonate-related osteonecrosis of the jaw (BRONJ) in a patient with osteoporosis using zoledronic acid and to report the results of a 1-year prospective clinical study regarding 5 immediately inserted implants in the anterior mandible. For this comparative prospective study, 24 female patients, aged ≥54 years, were chosen, all with partially edentulous mandibles. Group A consisted of 12 patients with osteoporosis taking zoledronic acid receiving a once-yearly intravenous infusion of zoledronic acid (5 mg). Control group B consisted of 12 other patients without osteoporosis and not taking drugs. In both groups, the remaining teeth were extracted before 120 implants, 3.7-mm wide and 16-mm long, were immediately installed in the interforaminal region of the mandibles. The 1-year implant survival rate was 100%. No apparent necrotic bone was observed among patients receiving zoledronic acid (group A) after implant surgery. Immediate implant osseointegration can be successful in a patient with osteoporosis using bisphosphonates, suggesting the safety of implantology as a treatment modality.

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.

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

BACKGROUND

At present, only some studies have dealt with immediate loading of unsplinted implants supporting mandibular overdentures. The aim of this prospective study is to evaluate treatment outcomes of mandibular overdentures supported by four one-piece, unsplinted, immediately loaded, direct laser metal-forming (DLMF) implants by assessing implant survival rate, implant success, marginal bone loss, and prosthetic complications.

METHODS

A total of 96 one-piece DLMF implants were inserted in the edentulous mandible of 24 patients. Four implants were placed in each edentulous mandible. Immediately after implant placement, a mandibular overdenture was connected to the implants. At 1-year follow-up, clinical, radiographic, and prosthetic parameters were assessed. Success criteria included absence of pain, suppuration, and implant mobility; absence of continuous peri-implant radiolucency; and distance between the implant shoulder and the first visible bone contact <1.5 mm.

RESULTS

After a 1-year loading time, the overall implant survival rate was 98.9%, with only one implant lost. Among the surviving 95 implants, two did not fulfill the success criteria; therefore, the implant success rate was 97.8%. The mean distance between the implant shoulder and the first visible bone contact was 0.28 ± 0.30 mm (95% confidence interval, 0.24 to 0.32). Some prosthetic complications were reported.

CONCLUSION

Based on the present results and within the limits of this study, the immediate loading of four unsplinted DLMF implants by means of ball attachment-supported mandibular overdentures seems to represent a safe and successful procedure.

Resonance frequency analysis of overdenture retainer implants with immediate loading

OBJECTIVE

To evaluate 16 patients of both sexes with lower overdenture and upper complete dentures, by analysing the resonance frequency of the initial and late stability of implants used to retain the overdenture under immediate loading.

BACKGROUND

Oral rehabilitation treatment with complete dentures using implants has been increasingly more common among the specialists in the oral rehabilitation area. This is an alternative for obtaining retention and stability in treatments involving conventional complete dentures, where two implants are enough to retain the overdenture satisfactorily.

MATERIALS AND METHODS

The Osstell™ Mentor device was used for the analysis in the initial period (primary stability), 3 and 15 months after the installation of the lower overdenture (secondary stability). The statistical analysis was performed with the repeated measures model (p < 0.01).

RESULTS

The implant stability quotients were observed to increase after 15 months of the rehabilitating treatment.

CONCLUSION

The use of overdentures over two lower implants should become the treatment of choice for individuals who have a fully edentulous mandible.

Loading protocols for mandibular implant overdentures: a systematic review with meta-analysis

BACKGROUND

Mandibular overdentures are a successful treatment option for the edentulous patients with long-term predictable outcomes, using conventional loading protocols. Currently, both early and immediate loading protocols for mandibular implant overdentures are prevalent in the literature.

PURPOSE

A systematic review and meta-analysis of the current published literature on comparative studies using conventional versus either early and/or immediate loading protocols for mandibular implant overdentures.

MATERIALS AND METHODS

The review was carried out in accordance with the QUOROM (Quality of Reporting of Meta-Analyses) guidelines. The PICO (Population, Intervention, Comparisons, Outcomes) format was used in conjunction with predefined inclusion criteria. A literature search of PubMed (1969-October 2008), EMBASE (1998-October 2008), the Cochrane Database of Systematic Reviews, and the Cochrane Controlled Trial Register was conducted. In addition, hand searching through refereed dental journals was also performed for the years 2000 to 2008. The meta-analysis was conducted by using the MIX software v.1.7 (Kitasato Clinical Research Center, Kanagawa, Japan).

RESULTS

A total of 191 studies were identified through the electronic search. After full-text screening and cross-matching with the predefined inclusion criteria, only 10 studies with a minimum follow-up of 2 years were eligible for inclusion in this review. Of the 10 included studies, seven have compared the outcome of conventional versus early loading of implants supporting mandibular overdentures. The remaining three studies, on the other hand, compared the outcome of conventional versus immediate loading. The meta-analysis revealed no significant difference in the outcome between conventional and either early (p = .72) or immediate (p = .08) loading of implants supporting mandibular implant overdentures.

CONCLUSIONS

Short-term outcomes of early or immediate loading protocols for mandibular implant overdentures achieved comparable success to conventional loading ones. No evidence was found of long-term studies to support or refute either early or immediate loading protocols for mandibular implant overdentures.

Implant restoration of partially edentulous ridges: a review of 121 Nigerian patients

OBJECTIVE

Because of increasing health awareness, many Nigerian patients are demanding that their lost tooth/teeth be replaced with dental implants. This study reports the pattern and distribution of implant replacement of lost tooth/teeth in a private dental practice in Lagos, Nigeria.

METHODS

A retrospective review of implant replacement of lost tooth/teeth over a period of 6 years at Schubbs Private Dental Clinic, Lagos, was carried out. Data analysis included age, sex, occupation, habits and medical condition of patients, augmentation procedure, technique of implant placement (immediate vs conventional loading) tooth/teeth replaced, and follow-up period.

RESULTS

A total of 227 implants (Bicon, Boston, MA) with complete superstructure were placed in 121 patients(males = 68, females = 53; age range: 15-74 years). Majority of the patients were of high socioeconomic class. Ten (8.3%) patients had immediate implants and 111 (91.7%) undergone 2-stage implant procedures. The highest number (39.2%) of implants was placed in the molar region, and the replacement of the canines was the lowest (3.1%). Success rate over a period of 6 years was 96%. Of the 9 (4%) implants that failed, 2 were repeated and remained functional till date.

CONCLUSIONS

Dental implant therapy as a means of tooth replacement is gaining popularity among Nigerian social upper class. Success rate in this series is comparable with previous reports from Europe and America.

Immediate implant loading: current status from available literature

The introduction of osseointegrated implants in dentistry represents a turning point in dental clinical practice. Thanks to their multiple therapeutic possibilities and the high predictability of success, implant therapy is now regarded as an extremely reliable approach to replace missing teeth. The concept of immediate implant loading has recently become popular due to less trauma, reduced overall treatment time, decreased patient's anxiety and discomfort, high patient acceptance and better function and esthetics. Nonetheless, research and understanding in this area are confuse and sometimes contradictory. Hence, it is the purpose of this review to provide rational for immediate implant loading, summarize current available literature, and analyze factors that influencing this newly introduced treatment method. Results from this review indicated that immediate implant loading achieved similar high success rate as that noted in the conventional approach (delayed protocols). However, a careful case selection, proper treatment plan, meticulous surgery and proper design of prosthesis are essential for optimal outcomes when this approach is adopted.

Immediate Loading of Two Implants Supporting a Ball Attachment-Retained Mandibular Overdenture: A Prospective Clinical Study

BACKGROUND

A prospective clinical study was conducted to evaluate clinically and radiographically the performance of two implants immediately loaded supporting a ball attachment-retained mandibular overdenture.

MATERIALS AND METHODS

Seventeen completely edentulous patients were included in the study. Each patient received two implants inserted after a minimal flap reflection and no vestibular extension in order to reduce the postoperative swelling and facilitate immediate prosthesis connection. After implant placement, a mandibular complete denture was connected to the implants using ball attachments of appropriate height according to the depth of the peri-implant tissue. Patients were asked not to remove the denture for 1 week. No limitations to chewing function were given. At implant placement, the maximum value of insertion torque was recorded. Patients were examined at 1, 2, 4, 12, and 52 weeks postsurgery. At postoperative visit, occlusion was checked and the need for any prosthesis maintenance was recorded. The radiographic bone level (RBL) change was measured on periapical radiographs at baseline and 12 months after loading.

RESULTS

After 12 months of loading, no implant failure was reported and the survival rate was 100%. Average RBL change was 0.7 mm +/- 0.5 mm. Of the 17 cases, two had major prosthetic complications and five patients required minor extra maintenance appointments.

CONCLUSIONS

The immediate loading of two implants by means of ball attachment-retained mandibular complete denture may be a predictable treatment option. This clinical approach offers increased stability and comfort, while keeping a high implant success rate.