In-patient comparison of immediate and conventional loaded implants in mandibular molar sites within 12 months

Immediate loading on two adjacent single dental implants with definitive nonsplinted restorations: A proof of concept in the posterior zone

OBJECTIVES

To evaluate clinical, clinician- and patient-reported outcomes (PROs) of two adjacent single posterior implants immediately loaded with definitive single crowns up to 1 year. Ten patients in need of two adjacent posterior single implants were included. All implants were placed applying a fully digital workflow. Definitive screw-retained single zirconia crowns were delivered within 72 h after implant placement. Clinical parameters, patient- and clinician-reported outcomes were assessed up to 1 year of follow-up.

CLINICAL CONSIDERATIONS

Clinical outcomes remained stable, with no implant failures or technical and biological complications throughout the observation period. Patient satisfaction was very high at baseline (crown delivery) and remained consistently high at 6 and 12 months of follow-up. Crown insertion 3 days after implant placement was rated as an easy procedure by clinicians.

CONCLUSIONS

Two adjacent single implants with immediate definitive restorations (<72 h) in the posterior region appear to be a viable and easy treatment option to shorten the overall treatment time and potentially enhancing patient satisfaction. However, randomized controlled trials are needed to confirm the advantages of this treatment protocol over a delayed loading approach.

CLINICAL SIGNIFICANCE

In selected cases, immediate implant loading with definitive restorations in the posterior region appears a valuable and straightforward option to shorten the overall treatment time.

Heterogeneity of outcomes in randomized controlled trials on implant prosthodontic therapy is hindering comparative effectiveness research: meta-research study

BACKGROUND

Consistency in outcomes across clinical trials allows for comparing and combining results from different studies. A core outcome set (COS), representing a minimally agreed standardized group of outcomes that should be monitored and measured through research in a specific field of medicine, is not yet available for trials in implant prosthodontic (dental implant) therapy. This meta-research study aimed to analyze outcomes used in clinical trials on implant prosthodontic therapy.

METHODS

We searched the Cochrane Oral Health Group (COHG) register to identify systematic reviews of interventions in implant prosthodontic therapy published by October 2023. From the randomized controlled trials (RCTs) included in the relevant reviews, we extracted data on the characteristics of the included trials and the outcomes used. We categorized outcomes into domains.

RESULTS

From 182 systematic reviews in the COHG register, we included 11 systematic reviews on dental implant therapy. The reviews included 117 unique RCTs with 4725 participants, published from 1995 to 2020, which analyzed 74 different outcomes. Using different definitions, implant failure was analyzed in 73 RCTs. Seventeen RCTs did not define implant failure. Failure was most often (30 RCTs) followed up for one year. Only one RCT assessed implant failure after five years. Trials used 17 definitions of implant failure, while 17 trials did not report on the criteria of implant failure. Complications were analyzed in 48 RCTs, although they were not clearly defined in 12 RCTs. Failure of prosthodontic supra-structure was analyzed in 74 RCTs, with definitions of failure and criteria not clearly defined in 44 RCTs. Trials considered adverse events, peri-implant tissue health, patient attitudes, and other outcomes, including cost, aesthetics, or procedure duration. These outcomes were often different between trials. Twenty-six outcomes were used only once per study.

CONCLUSIONS

Clinical trials in implant prosthodontics used different outcomes, different definitions of outcomes and used different times to monitor them. Standardization of outcomes is necessary to allow comparability and evidence synthesis about the effectiveness of implant prosthodontic therapy.

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.

Marginal bone level change during sequential loading periods of partial edentulous rehabilitation using immediately loaded self-tapping implants: a 6.5-year retrospective study

PURPOSE

A large number of studies have suggested the practicability and predictability of immediate implant function, but few studies have reported marginal bone level changes during sequential loading periods. The purpose of this study was to evaluate the marginal bone remodeling of immediately loaded self-tapping implants both at each time point and during each loading period between two time points.

MATERIALS AND METHODS

The patients included in this retrospective study were treated with immediately loaded NobelSpeedy Replace implants between August 2008 and July 2009. Differences in the marginal bone level (MBL) at each time point and the marginal bone level change (ΔMBL) between two time points were analyzed with Bonferroni correction (P < .05).

RESULTS

Overall, 24 patients (mean age, 47.3 ± 12.8 years) with 42 immediately loaded implants and a median follow-up of 6.5 years (IQR, 67.8 months) were included. The cumulative survival rate after 10 - 12 years was 95.2%. Continuous but slow marginal bone loss was observed during long-term follow-up. MBL at both 7.5 years and 11 years was significantly lower than that at loading, 6 months, 2 years and 4 years (P < .05). No bone loss difference was found in any period before 4 years of follow up (P > .05). The loading period of 4 years to 7.5 years showed the largest ΔMBL compared to those of other time periods (P < .05).

CONCLUSION

Slight bone loss occurred continuously, and more radical changes of marginal bone can be observed during the period of 4-7.5 years. Thus, long-term effective follow-up of immediately loaded implants is needed.

Maintenance requirements and marginal bone loss associated with implant-retained overdentures: a retrospective cohort study

OBJECTIVES

To evaluate the maintenance requirements and the presence of prosthetic complications associated with marginal bone loss in the implant-retained bar and locator prostheses.

MATERIALS AND METHODS

The study was executed between the years 2013 and 2018 on 114 patients who had undergone 283 dental implants. Patients were examined at follow-up recall sessions at 12 and 24 months after the placement of the dentures. The clinical examination also included intraoral and extraoral examinations of the patients; compatibility of the prostheses placed to about occlusion; an adaptation of the prosthesis to the tissues, health, and continuity of the soft tissues; complaints of the patients; implant success rates; and marginal bone loss, and prosthetic complications were evaluated at follow-up sessions, and statistical analysis was performed.

RESULTS

Locator attachment was placed in 94 patients with separated mandibles and maxillae, and a removable prosthesis with a bar attachment was placed in 20 patients. When evaluating the level of marginal bone loss regardless of the presence of complications, the area where the implant was set, the number of days after loading, and the type of retainer, it was found to be significant at the end of the 12th the 24th months. The results showed a significant relationship between the prosthesis type and the presence of complications at month 24 (p < 0.05). There was no significant relationship between the position of the denture and the presence of complications at month 12 (p > 0.05). There was no significant relationship between the location of the denture and the presence of complications at month 24 (p > 0.05).

CONCLUSION

Complications do not affect marginal bone loss, but the resulting marginal bone loss is the result of the patient not paying enough attention to oral hygiene. Routine inspections of the prosthesis after the completion of treatment seem to be important. If the requirements resulting from these checks are met, complications that may occur in the future will be prevented.

CLINICAL RELEVANCE

The maintenance requirements and the presence of prosthetic complications associated with marginal bone loss in the implant-retained bar and locator prostheses were evaluated. Complications occurred more frequently with the bar-supported removable implant prostheses.

Clinical efficacy of anodized dental implants for implant-supported prostheses after different loading protocols: A systematic review and meta-analysis

OBJECTIVES

To summarize the clinical performance of anodized implants connected to different prostheses design after immediate/early (IL) or conventional loading (CL) protocols.

MATERIALS AND METHODS

Seven databases were surveyed for randomized (RCTs) and non-randomized controlled clinical trials (CCTs). Studies comparing IL vs. CL protocol of anodized implants supporting single crown, fixed partial denture (FPD), full-arch fixed dental prosthesis (FDP), or overdenture were included. Risk-of-bias was evaluated using Cochrane Collaboration tools. Meta-analyses for different follow-up were analyzed, followed by heterogeneity source assessment and GRADE approach. The outcomes included implant survival rate, marginal bone loss (MBL), implant stability quotient (ISQ), probing depth (PD), plaque index (PI), and peri-implantitis prevalence.

RESULTS

From 24 eligible studies, 22 were included for quantitative evaluation. Most RCTs (58%, n = 11) and all the 5 CCTs had high and serious risk-of-bias, respectively. Overall, pooling all prosthesis design, no difference between IL vs. CL protocols was observed for all outcomes (p > .05). However, according to prosthesis type subgroups, CL reduced MBL for full-arch FDP (p < .05). In a point-in-time assessment, with overdenture, although IL presented higher PI (12 months), it showed lower MBL (≥24 months), higher ISQ (3 months), and lower PD (6 and 12 months) (p < .05). Conversely, PD was higher for IL in single crown (3 and 6 months) (p < .05). Regarding MBL, IL demonstrated higher mean difference for full-arch FDP (36 months) and FPD (12 and 36 months) (p < .05).

CONCLUSION

Within the limitations of this study, overall, there is no significant difference in the outcomes between IL and CL loading protocols.

Correlation of Implant Stability Between Two Noninvasive Methods Using Submerged and Nonsubmerged Healing Protocols: A Randomized Clinical Trial

Various invasive and noninvasive methods have been used for measuring primary implant stability. Periotest damping device and resonance frequency analysis with the Osstell device have been classified as noninvasive methods. Primary and secondary implant stability measurements using both devices have given reproducible quantitative values. In this clinical randomized trial, a general correlation was evaluated between the implant stability recorded using both Osstell and Periotest devices on the day of implant installation and 3 months after healing for the submerged and nonsubmerged loading protocols. The present study also investigated whether the difference in gender of the included patients would have an effect on the correlation between the two devices. Eighty completely edentulous patients were recruited, and all patients ranged from 50 to 69 years of age. Overall, 56 men and 24 women were included, with a mean age of 62.5 years for men and 59.6 years for women. A single implant was installed in the midline of the completely edentulous mandible to improve retention of the patient's lower denture. After implant installation, one implant stability quotient (ISQ) value at the buccal surface was recorded, and then the Periotest M device was used to measure the damping effect (Periotest value [PTV]) of the installed implant using the smart peg screwed to the implant. Patients were then randomized into 2 groups using sealed envelopes: the submerged and nonsubmerged groups. For both groups, all ISQ and Periotest readings were recorded in the patient's case report file on the day of implant installation and 3 months after healing. When the ISQ of the buccal surface was correlated to the PTV, there was a moderate negative statistically significant correlation between the 2 readings (correlation coefficient = -.466, P = .000). There tended to be a weak negative correlation between the 2 devices in the male group (correlation coefficient = .395, P = .046) during implant installation, although there tended to be no correlation between the 2 devices in the female group (correlation coefficient = -.367, P = .342). After 3 months of healing, when correlating the readings of the buccal surface of the Osstell with that of the Periotest within each group (submerged and nonsubmerged), there was no statistically significant correlation between the readings within each group (correlation coefficient = -.014, -.430, P = .942, P = .052, respectively). However, there was a strong negative statistically significant correlation between the 2 devices for the female group for both the nonsubmerged group (correlation coefficient = -.823, P = .003) and submerged group (correlation coefficient = -.857, P = .014), whereas there was no statistically significant correlation within the male group for both the nonsubmerged group (correlation coefficient = -.377, P = .123) and submerged group (correlation coefficient = -.022, P = .940). The correlation between the Osstel and Periotest device remains controversial. The present study concluded that there is a significant negative correlation between the 2 devices when recording primary implant stability, although this significance is lost after 3 months of loading when recording secondary implant stability. Gender also affects the implant stability recording, which is mainly due to the difference in bone density between men and women.

The clinical significance of implant stability quotient (ISQ) measurements: A literature review

Implant stability quotients (ISQ values) are obtained in dental clinical practice on a non-invasive basis by resonance frequency measurement rapidly after surgical placement of implants. The ISQ-values are used as indicator for mechanical implant stability, and are believed to have predictive power for clinical outcome. It is the aim of this review to provide a synopsis of all factors described in the literature that influence ISQ measurements by performing an exhaustive literature review; moreover, this review aims at elucidating the key factors relevant for a rapid clinical predictive assessment. We searched systematically and exhaustively all major databases for publications relating to ISQ measurement methodology and for ISQ-influencing factor analyses. The reports identified were ordered in experimental (preclinical) studies and in clinical publications. We were able to identify 13 basic factors influencing ISQ-measurements. Among these, local bone quality, playing a key role in such measurements, was subdivided in four specific subfactors; thus a total of 17 individual factors was identified and reported to influence ISQ-measurements. A comprehensive list of these factors is provided in Table-form. A critical analysis points out that only 6 of these factors are of a sound predictive power useful for a rapid clinical assessment; and only two of these factors appear to have a well-documented scientific basis.

Immediate versus early or conventional loading dental implants with fixed prostheses: A systematic review and meta-analysis of randomized controlled clinical trials

STATEMENT OF PROBLEM

Immediate loading of dental implants has gained widespread popularity because of its advantages in shortening treatment duration and improving esthetics and patient acceptance. However, whether immediate loading can achieve clinical outcomes comparable with those of early or conventional delayed loading is still unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to compare the efficacy of immediate loading versus early or conventional loading implants in patients rehabilitated with fixed prostheses.

MATERIAL AND METHODS

Electronic searches of CENTRAL, EMBASE, and MEDLINE were supplemented by manual searches up to October 2018. Only human randomized controlled trials (RCTs) comparing immediate with early or conventional loading dental implants were included. Quality assessment was performed by using the Cochrane Collaboration tool. For the meta-analysis, the dichotomous and continuous variables were pooled and analyzed by using risk ratios (RRs) and weighted mean differences (WMDs), with 95% confidence intervals (95% CIs). The outcomes assessed included survival rate, marginal bone level changes, peri-implant gingival level, probing depth, and implant stability. The subgroup analyses included healing methods, implant time, occlusal contact, number of missing teeth, and tooth position.

RESULTS

Thirty-nine trials (49 articles) were included from the initial 763 references evaluated. When compared with conventional loading, with implants regarded as a statistical unit, a statistically significant lower survival rate was observed in the immediate loading dental implant (RR=0.974; 95% CI, 0.954, 0.994; P=.012). Regarding other outcomes, including marginal bone level changes, peri-implant gingival level, probing depth, and implant stability, no statistically significant differences were observed when comparing immediate versus early or conventional loading (P>.05).

CONCLUSIONS

Compared with early loading, immediate loading could achieve comparable implant survival rates and marginal bone level changes. Compared with conventional loading, immediate loading was associated with a higher incidence of implant failure.

Comparative evaluation of the influence of immediate versus delayed loading protocols of dental implants: A radiographic and clinical study

Aim:

Immediate loading protocol, in recent times, has gained popularity as it has not only shortened the treatment time but also resulted in enhanced patient satisfaction. The aim of this study was to evaluate and compare the effectiveness of immediate implant loading protocol over conventional implant loading protocol with respect to peri-implant bone loss.

Materials and Methods:

Twenty patients selected for this study were divided into two groups. In Group I patients, implants were immediately loaded, whereas in Group II, they were loaded with conventional loading protocol. Peri-implant bone loss was measured and compared using intraoral periapical radiographs with the grid at the time of implant loading, 1, 3, and 6 months after implant loading.

Results:

Change in radiographic bone loss in both the groups was found to be statistically significant when baseline was compared to 1, 3, and 6 months, but the difference in the bone loss between Group I and II was not found to be statistically significant.

Conclusion:

No statistically significant difference was observed in the crestal bone loss on comparison of immediate loading to delayed loading protocol.

Clinical Significance:

After achieving good primary stability, immediate-loaded implants can be used for the benefit of the patients as it reduces the period of edentulism.

Effect of the different implant protocols on peri-implant bone: a 6-month prospective study in beagle dogs

OBJECTIVE

To compare the effects of different implant placement and loading protocols on the marginal bone loss (MBL) in beagles by intraoral radiography.

METHODS AND MATERIALS

61 dental implants were inserted on 9 beagle dogs at bilateral lower posteriors according to 8 different protocols: immediate implant placement and immediate loading for 3 months (IIP + IL3) or 6 months (IIP + IL6) and unloading (IIP + UL), immediate implant placement and delayed loading for 3 months (IIP + DL3) or 6 months (IIP + DL6), delayed implant placement and immediate loading for 3 months (DIP + IL3) or delayed loading for 3 months (DIP + DL3) and unloading (DIP + UL). Intraoral radiography was performed to analyze the MBL during each surgery, before and after the implant placement and at 3-month intervals after the procedure.

RESULTS

In total, 57 samples were included. There was less MBL (p<0.05) in the IIP + IL3 group (1.22 ± 0.63 mm) compared to the DIP + IL3 group (1.89 ± 0.9 mm). The longer the loading time, the more bone loss appeared in the IIP + IL group; however, the results were reversed in the IIP + DL group. The MBL during the latter 3-month period was dramatically decreased compared to the former 3-month period in the IIP + DL3 group (p<0.05).

CONCLUSIONS

The IIP + IL group seems superior to the DL protocol and the MBL changed significantly during the first three months and thereafter became stable.

The role of immediate provisional restorations on implants with a hydrophilic surface: A randomised, single-blind controlled clinical trial

OBJECTIVES

To compare the radiographic bone changes, clinical parameters and aesthetic outcomes of immediately provisionalised and conventionally restored implants at 12- and 24-months post-implant placement.

MATERIAL AND METHODS

In 24 patients, 24 bone level implants with a hydrophilic (SLActive) surface were placed in healed sites and they were either immediately provisionalised with a non-occluding temporary crown (test group) or left without a crown (control group). In both groups, the definitive restoration was placed 16 weeks after implant placement. Clinical and radiographic parameters were calculated at 12- and 24-months post-implant placement, together with implant success/survival rates according to three different sets of criteria. The aesthetic outcome was evaluated through the Papilla Fill Index and the Pink Aesthetic Score.

RESULTS

The mean marginal bone loss at 1 year was -0.73 mm (SD 0.83 mm) in the test group and -0.22 mm (SD 0.46 mm) in the control group (p > .05). Whilst 100% survival rate and positive aesthetic outcomes were recorded in both groups, three patients of the test group did not fulfil all success criteria.

CONCLUSIONS

Immediate provisionalisation may represent a viable option for the replacement of single missing teeth, with radiographic, clinical and aesthetic results comparable to those of conventionally loaded implants at 2 years of follow-up.

Comparison between inflammation-related markers in peri-implant crevicular fluid and clinical parameters during osseointegration in edentulous jaws

OBJECTIVES

The aim of this study is to improve the understanding of interleukin mechanisms during osseointegration to enhance the monitoring of implant failure and success. Clinical parameters, implant stability, and cytokine levels in peri-implant crevicular fluid (PICF) during early bone healing after implant placement were investigated.

MATERIAL AND METHODS

Sixty narrow implants were placed in mandible anterior region of 30 edentulous patients (67.23 ± 7.66 years). Bone type, insertion torque, and primary stability were registered during surgery. Clinical measurements of peri-implant health and the secondary implant stability quotient (ISQ) were recorded. Samples from the PICF were collected 1, 2, 4, 8, and 12 weeks after surgery and analyzed for IL-1β, IL-6, IL-10, and TNF-α levels using ELISAs.

RESULTS

The gingival index increased significantly during the first week (p = 0.05), while the plaque index increased significantly between 4 to 8 and 8 to 12 weeks (p < 0.05). The probing depth and the ISQ also reduced significantly (p < 0.05) over time. The TNF-α release increased significantly after the 2nd week for non-atrophic patients and 4th week for atrophic patients (p < 0.05). The IL-1β concentrations showed a short-lived peak after 1st week (p = 0.003), specially in atrophic patients and sites with bone type I (p = 0.034; p = 0.007). The IL-6 concentrations peaked during the 1st and 2nd weeks (p < 0.05; p = 0.005) in atrophic patients and in bone type II (p = 0.023; p = 0.003). The IL-10 concentrations increased gradually over time, showing the highest concentrations at the 12th week (p < 0.005). A total of 12 implants failed at different periods.

CONCLUSION

While the clinical measurements presented differences between the evaluation periods, these were not indicative of early dental implant failure or peri-implant diseases. Smoking, bone atrophy, and bone type can greatly influence the cytokines concentrations during the healing time.

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.

Factors Affecting Dental Implant Stability Measured Using the Ostell Mentor Device: A Systematic Review

OBJECTIVES

The aim of this study was to review the literature on factors that may affect dental implant stability as measured with the Ostell mentor device.

MATERIALS AND METHODS

A systematic search of the literature was performed in Pubmed, Scopus, and Cochrane databases using dental implants, stability, and resonance frequency analysis as key words.

RESULTS

The most relevant randomized controlled trials and clinical trials (n = 39) were selected from among 264 articles.

CONCLUSIONS

Many factors can affect dental implant stability as measured with the Ostell mentor device. This may be a useful instrument for deciding the timing of implant loading, but additional research is required to establish the reliability and predictability of resonance frequency analysis for the future osseointegration of dental implants, which remains controversial.

Dental Implants With Immediate Loading Using Insertion Torque of 30 Ncm: A Systematic Review

OBJECTIVE

This study aimed to perform a review of the literature regarding the survival rate of dental implants with immediate loading using insertion torque of 30 Ncm.

MATERIAL AND METHODS

A systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Handbook for Systematic Reviews of Interventions (PROSPERO CRD42014015323). The search was performed in the PubMed, Web of Science, Cochrane Library electronic, OVID, and Scielo databases. Manual searches were also performed. The articles identified were assessed independently by 3 researchers. Clinical trials reporting dental implants with immediate loading and 30 Ncm torque in patients ages 18 years or older were included.

RESULTS

The searches yielded 589 studies. Six studies were included in the systematic review. The survival rate of dental implants was 96.8%. Three studies showed a low potential risk of bias.

CONCLUSION

There is not strong evidence that insertion torque of 30 Ncm is enough for implant survival in cases of immediate loading.

Immediate loading for implant restoration compared with early or conventional loading: A meta-analysis

PURPOSE

This meta-analysis was to further confirm the no inferiority of immediate loading in clinical and radiographic outcomes compared with non-immediate loadings (early or conventional loading).

MATERIALS AND METHODS

Literature search on Pubmed and Embase was performed up to August 2015. The overall risk radios (RRs) and standard mean differences (SMDs) as well as their 95% confidence intervals (CI) were calculated for comparison.

RESULTS

Total 29 RCT with 1342 implants receiving immediate loading and 1279 implants receiving non-immediate loadings were included in this meta-analysis. Results indicated that there was no significant difference between immediate and non-immediate loadings in implant failure rate based on patients (RR = 1.45, 95% CI: 0.79 to 2.68) and implants (RR = 1.38, 95% CI: 0.86 to 2.21), MBL (SMD = -0.11, 95% CI: -0.39 to 0.17), and ISQ (SMD = -0.26, 95% CI: -0.53 to 0.01). Meanwhile, immediate loading showed significantly less MBL change than non-immediate loading. In addition, subgroup analyses showed that the immediate loading indicated slightly higher implant failure rate and lower ISQ than conventional loading.

CONCLUSIONS

Although overall analysis confirmed no inferiority of immediate loading compared with non-immediate loadings, the technique still need to be explored for improving implant success and stability during immediate loading based on the results in subgroup analyses.

Immediate versus conventional loaded single implants in the posterior mandible: a meta-analysis of randomized controlled trials

The purpose of this meta-analysis was to compare implant survival, marginal bone loss, and complications between immediate and conventional loading of single implants installed in the posterior mandible. An extensive electronic search was performed of PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials to identify relevant articles published up to January 2015. After the selection process, five studies met the eligibility criteria and were included. The results of the meta-analysis were expressed in terms of the odds ratio (OR) or standardized mean difference (SMD), with a confidence interval (CI) of 95%. Results were pooled according to heterogeneity using the fixed- or random-effects model. There was no statistically significant difference between the two techniques (immediate loading vs. conventional loading) with regard to implant survival (OR 1.71, 95% CI 0.40 to 7.36; P=0.47). There was no statistically significant difference in marginal bone loss (SMD -0.58, 95% CI -1.55 to 0.38; P=0.24). The reported mechanical and biological complications were common to both types of intervention, with the exception of probing depth, which was greater following the immediate loading technique (SMD 0.13, 95% CI -0.19 to 0.44), although this was not statistically significant (P=0.43).

Clinical efficacy of immediate implant loading protocols compared to conventional loading depending on the type of the restoration: a systematic review

BACKGROUND AND OBJECTIVES

Immediate loading has become a predictable option to restore all clinical situations. The aim of this systematic review was to assess whether immediate loading protocols achieve comparable clinical outcomes when compared to conventional loading protocols depending on the type of prosthetic restoration.

METHODS

A protocol was developed aimed to answer the following focused question: "What are the effects of immediate implant loading protocols compared to conventional implant loading, in terms of implant failure, marginal bone levels, and biological and mechanical complications based on the type of restoration?" The next subanalysis were performed as follows: the extent, type, and material of the restoration and the type of occlusal contact in function. This systematic review only included randomized controlled trials (RCTs) with a follow-up of at least 6 months after implant loading.

RESULTS

Thirty-seven final papers were included. The results from the meta-analyses have shown that the immediately loading implants demonstrated a statistically significant higher risk of implant failure [RR = 1.92; 95% CI (1.04; 3.54); P = 0.036], a statistically significant lower bone loss [WMD = 0.046; 95% CI (0.043; 0.049); P = 0.000] and a smaller increase in ISQ values [WMD = -1.096; 95% CI (-1.615; -0.577); P < 0.001, although both groups attained high survival rates (98.2% in the test and 99.6% in the control). Single teeth implants were greater risk of failure, when compared to immediately loaded full arch restorations (RR = 2 vs. 0.9), so as the occlusal pattern when compared to non-occlusal (RR = 1.9 vs. 1.4).

CONCLUSIONS

Immediate loading may impose a greater risk for implant failure when compared to conventional loading, although the survival rates were high for both groups.

Immediate loading: from biology to biomechanics. Report of the Committee on Research in fixed Prosthodontics of the American Academy of fixed Prosthodontics

One of the key issues of modern implant rehabilitation is the overall shortening of treatment time. High survival rates for immediately loaded implants have been reported in many but not all treatment modalities. In recent years, considerable evidence for the successful immediate loading outcome has been documented in both animal and human studies. The mechanical force generated by immediate loading may explain the favorable biologic response of bone and surrounding tissue when the design is biomechanically sound. However, in certain treatment modalities, including but not limited to immediately placed maxillary anterior single implants, immediately placed single molar implants, unsplinted implants in overdentures, and implants in maxillary anterior partial fixed dental prostheses, loading dental implants indiscriminately and immediately is not safe because of potentially unfavorable stress distribution and a negative cellular response under such high stress during early healing.

Occlusion on oral implants: current clinical guidelines

Proper implant occlusion is essential for adequate oral function and the prevention of adverse consequences, such as implant overloading. Dental implants are thought to be more prone to occlusal overloading than natural teeth because of the loss of the periodontal ligament, which provides shock absorption and periodontal mechanoreceptors, which provide tactile sensitivity and proprioceptive motion feedback. Although many guidelines and theories on implant occlusion have been proposed, few have provided strong supportive evidence. Thus, we performed a narrative literature review to ascertain the influence of implant occlusion on the occurrence of complications of implant treatment and discuss the clinical considerations focused on the overloading factors at present. The search terms were 'dental implant', 'dental implantation', 'dental occlusion' and 'dental prosthesis'. The inclusion criteria were literature published in English up to September 2013. Randomised controlled trials (RCTs), prospective cohort studies and case-control studies with at least 20 cases and 12 months follow-up interval were included. Based on the selected literature, this review explores factors related to the implant prosthesis (cantilever, crown/implant ratio, premature contact, occlusal scheme, implant-abutment connection, splinting implants and tooth-implant connection) and other considerations, such as the number, diameter, length and angulation of implants. Over 700 abstracts were reviewed, from which more than 30 manuscripts were included. We found insufficient evidence to establish firm clinical guidelines for implant occlusion. To discuss the ideal occlusion for implants, further well-designed RCTs are required in the future.

Reasons for failures of oral implants

This study reviews the literature regarding the factors contributing to failures of dental implants. An electronic search was undertaken including papers from 2004 onwards. The titles and abstracts from these results were read to identify studies within the selection criteria. All reference lists of the selected studies were then hand-searched, this time without time restrictions. A narrative review discussed some findings from the first two parts where separate data from non-comparative studies may have indicated conclusions different from those possible to draw in the systematic analysis. It may be suggested that the following situations are correlated to increase the implant failure rate: a low insertion torque of implants that are planned to be immediately or early loaded, inexperienced surgeons inserting the implants, implant insertion in the maxilla, implant insertion in the posterior region of the jaws, implants in heavy smokers, implant insertion in bone qualities type III and IV, implant insertion in places with small bone volumes, use of shorter length implants, greater number of implants placed per patient, lack of initial implant stability, use of cylindrical (non-threaded) implants and prosthetic rehabilitation with implant-supported overdentures. Moreover, it may be suggested that the following situations may be correlated with an increase in the implant failure rate: use of the non-submerged technique, immediate loading, implant insertion in fresh extraction sockets, smaller diameter implants. Some recently published studies suggest that modern, moderately rough implants may present with similar results irrespective if placed in maxillas, in smoking patients or using only short implants.

Interventions for replacing missing teeth: different times for loading dental implants

BACKGROUND

To minimise the risk of implant failures after their placement, dental implants are kept load-free for 3 to 8 months to establish osseointegration (conventional loading). It would be beneficial if the healing period could be shortened without jeopardising implant success. Nowadays implants are loaded early and even immediately and it would be useful to know whether there is a difference in success rates between immediately and early loaded implants compared with conventionally loaded implants.

OBJECTIVES

To evaluate the effects of (1) immediate (within 1 week), early (between 1 week and 2 months), and conventional (after 2 months) loading of osseointegrated implants; (2) immediate occlusal versus non-occlusal loading and early occlusal versus non-occlusal loading; (3) direct loading versus progressive loading immediately, early and conventionally.

SEARCH METHODS

The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 8 June 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2012, Issue 4), MEDLINE via OVID (1946 to 8 June 2012) and EMBASE via OVID (1980 to 8 June 2012). Authors of identified trials were contacted to find unpublished randomised controlled trials (RCTs). There were no restrictions regarding language or date of publication.

SELECTION CRITERIA

All RCTs of root-form osseointegrated dental implants, having a follow-up of 4 months to 1 year, comparing the same implant type immediately, early or conventionally loaded, occlusally or non-occlusally loaded, or progressively loaded or not. Outcome measures were: prosthesis and implant failures and radiographic marginal bone level changes.

DATA COLLECTION AND ANALYSIS

Data were independently extracted, in duplicate, by at least two review authors. Trial authors were contacted for missing information. Risk of bias was assessed for each trial by at least two review authors, and data were extracted independently, and in duplicate. Results were combined using fixed-effect models with mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). A summary of findings table of the main findings was constructed.

MAIN RESULTS

Forty-five RCTs were identified and, from these, 26 trials including a total of 1217 participants and 2120 implants were included. Three trials were at low risk of bias, 12 were at high risk of bias and for the remaining 11 the risk of bias was unclear. In nine of the included studies there were no prosthetic failures within the first year, with no implant failures in 7 studies and the mean rate of implant failure in all 26 trials was a low 2.5%. From 15 RCTs comparing immediate with convential loading there was no evidence of a difference in either prosthesis failure (RR 1.87; 95% CI 0.70 to 5.01; 8 trials) or implant failure (RR 1.65; 95% CI 0.68 to 3.98; 10 trials) in the first year, but there is some evidence of a small reduction in bone loss favouring immediate loading (MD -0.10 mm; 95% CI -0.20 to -0.01; P = 0.03; 9 trials), with some heterogeneity (Tau² = 0.01; Chi² = 14.37, df = 8 (P = 0.07); I² = 44%). However, this very small difference may not be clinically important. From three RCTs which compared early loading with conventional loading, there is insufficient evidence to determine whether or not there is a clinically important difference in prosthesis failure, implant failure or bone loss. Six RCTs compared immediate and early loading and found insufficient evidence to determine whether or not there is a clinically important difference in prosthesis failure, implant failure or bone loss. From the two trials which compared occlusal loading with non-occlusal loading there is insufficient evidence to determine whether there is a clinically important difference in the outcomes of prosthesis failure, implant failure or bone loss. We did not identify any trials which evaluated progressive loading of implants.

AUTHORS' CONCLUSIONS

Overall there was no convincing evidence of a clinically important difference in prosthesis failure, implant failure, or bone loss associated with different loading times of implants. More well-designed RCTs are needed and should be reported according to the CONSORT guidelines (www.consort-statement.org/).

A comparative analysis of periimplant bone levels of immediate and conventionally loaded implants

BACKGROUND

With the trend of shortening the treatment time and reducing patient discomfort/inconveniences immediate loading of implants has emerged as an alternative approach for replacing missing natural teeth. The aim of this study is to evaluate and compare the effectiveness of immediate implant loading protocol over conventional implant loading protocol in partially edentulous mandible.

METHODS

Twenty patients were selected from out patients department who needed the replacement of one of the missing mandibular first molar. They were divided into two groups. In Group A patients implants were loaded with immediate implant loading protocol, whereas in Group B they were loaded with conventional loading protocol. Periimplant bone loss and soft tissue health were measured and compared using OPG and IOPA radiographs 06 and 12 months after implant placement.

RESULTS

One implant failed in immediate loading group (Group A), whereas all implants survived in conventional loading group (Group B). The average periimplant bone loss after 6 months and 1 year for Group A were 0.69 mm and 1.09 mm respectively, whereas it was 0.74 mm and 1.13 mm respectively for Group B. The difference in the bone loss between Group A and B was not statistically significant.

CONCLUSION

Immediate implant loading protocol has a highly acceptable clinical success rate in partially edentulous lower jaw although implant survival rate is slightly inferior to conventional loading protocol.

Immediate provisional restoration of single-piece zirconia implants: a prospective case series - results after 24 months of clinical function

OBJECTIVE

Aim of this prospective case series was to evaluate the outcome of immediately provisionalized single-piece zirconia implants.

MATERIAL AND METHODS

A total of 20 zirconia implants were inserted in single-tooth gaps in the maxilla (11) and mandible (9) of 20 patients. Implants were restored with all-ceramic CAD/CAM provisionals without occlusal contacts immediately after placement. Permanent all-ceramic restoration was performed 4 months after surgery. Plaque index (PI), bleeding on probing (BOP), Periotest(®) (PV), pink aesthetic score (PES), mean radiographic marginal bone levels (MBL), implant survival and success were evaluated up to 24 months.

RESULTS

Assessment of PI at baseline and follow-ups after 6, 12, 18 and 24 months revealed 27% (±5.3), 24% (±6), 23% (±6.1), 23% (±5.3) and 22% (±6.4), respectively. Evaluation of BOP revealed 25% (±5.6), 21% (±6), 21% (±7.2), 18% (±5.9) and 15% (±5.5), respectively. Implants presented stable at follow-ups (PV). PES improved, but not statistically significant from 8.13 (±1.5) at baseline to 10 (±2) 24 months after implantation. Measurements of MBL showed a significant bone loss of 1.01 mm within the first year after placement (P < 0.001) and 1.29 mm 24 months post-implant insertion, not reaching further statistically significant levels (P > 0.05). One implant was lost 4 months after placement, resulting in a survival and success rate of 95%.

CONCLUSION

Clinical and radiographic parameters demonstrated a 95% integration of immediately loaded zirconia single-piece implants. A long-term randomized-controlled clinical trial was initiated to confirm evidence of this protocol.

The Role of Timing of Loading on Later Marginal Bone Loss Around Dental Implants: A Retrospective Clinical Study

The aim of this study was to assess the relation between marginal bone loss (MBL) around dental implants after a loading period of 36 months and the timing of loading. A total of 87 patients with 252 implants were included in the study group. The time span from implant placement to beginning of loading of the implants was evaluated. Delay of loading of implants seems to increase MBL around dental implants as the result of disuse atrophy. Implants next to a tooth on 1 or 2 sides suffered less from MBL. No statistically significant difference in MBL rate was noted between single and splinted implants or between smooth collar and microgeometry neck implants. Results of this study encourage early loading, especially for the mandibular overdenture supporting implants.

Immediate provisional restoration of screw-type implants in the posterior mandible: results after 5 years of clinical function

OBJECTIVE

The aim of this prospective study was to evaluate the outcome of immediately provisionally restored implants in the posterior mandible after a minimum of 60 months in function.

MATERIAL AND METHODS

Twenty-four patients were treated with 40 screw-type implants replacing mandibular molars and premolars. Implants were provisionalized immediately after placement. Radiographic coronal bone levels, implant survival and success were evaluated 12, 24, 36, 48 and 60 months after the final restoration.

RESULTS

Measurements of the mean marginal bone levels around immediately loaded implants after 12 months showed a significant bone loss (P<0.001) within the first year after the final restoration. Measurements of coronal bone levels after 24, 36, 48 and 60 months, respectively, showed no further significant increase of bone resorption. Two implants were lost within the first year after the final restoration, resulting in an overall survival rate of 95%; a total of three implants were recorded as failures (two implant losses and one excessive bone resorption above 50%), resulting in an overall success rate of 92.5 after an implant observation period of up to 8 years.

CONCLUSION

The present data revealed results comparable to conventionally loaded implants. Careful patient selection in combination with high primary stability seem to be key factors for immediately loaded implants. Larger long-term randomized clinical trials are needed to confirm the final evidence of this protocol as the standard treatment concept for the partially edentulous mandible.

Interventions for replacing missing teeth: different times for loading dental implants

BACKGROUND

To minimize the risk of implant failure, osseointegrated dental implants are conventionally kept load-free during the healing period. During healing removable prostheses are used, however many patients find these temporary prostheses rather uncomfortable and it would be beneficial if the healing period could be shortened without jeopardizing implant success. Nowadays immediately and early loaded implants are commonly used in mandibles (lower jaws) of good bone quality. It would be useful to know whether there is a difference in success rates between immediately or early loaded implants compared with conventionally loaded implants.

OBJECTIVES

To evaluate the efficacy of (1) immediate (within 1 week), early (between 1 week and 2 months), and conventional (after 2 months) loading of osseointegrated implants, and of (2) immediate occlusal versus non-occlusal loading during the bone healing phase.

SEARCH STRATEGY

The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. Handsearching included several dental journals. Authors of all identified trials, an Internet discussion group and 55 dental implant manufacturers were contacted to find unpublished randomised controlled trials (RCTs). The last electronic search was conducted on 4 June 2008.

SELECTION CRITERIA

All RCTs of root-form osseointegrated dental implants, having a follow up of 4 months to 1 year, comparing the same implant type immediately, early and conventionally loaded or occlusally and non-occlusally loaded. Outcome measures were: prosthesis and implant failures and radiographic marginal bone level changes.

DATA COLLECTION AND ANALYSIS

Data were independently extracted, in duplicate, by two review authors. Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Collaboration's statistical guidelines were followed.

MAIN RESULTS

Thirty RCTs were identified and 22 trials including 976 participants in total were included. Twelve trials compared immediate versus conventional loading, three early versus conventional loading, six immediate versus early loading, and one occlusally versus non-occlusally loaded implants. On a patient, rather than per implant basis, there were no statistically significant differences for any of the meta-analyses.

AUTHORS' CONCLUSIONS

It is possible to successfully load dental implants immediately or early after their placement in selected patients, though not all clinicians may achieve optimal results. It is unclear whether it is beneficial to avoid occlusal contacts during the osseointegration phase. Trends suggest that immediately loaded implants fail more often than those conventionally loaded, but less commonly than those loaded early. If a clinician wishes to load the implants early, it might be wiser to load them immediately (within 1 week) rather than waiting for 1 or 2 months. A high degree of primary implant stability (high value of insertion torque) seems to be one of the prerequisites for a successful immediate/early loading procedure. More well designed RCTs are needed and should be reported according to the CONSORT guidelines (www.consort-statement.org/).