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Immediate functional loading of Brånemark System implants with enhanced initial stability: a prospective 1- to 2-year clinical and radiographic study.

BACKGROUND: The interest in the benefits of immediate loading of titanium implants has recently involved fixed prostheses for partially edentulous areas. The advantages of this approach well justify the need for extending the procedure to all regions of the mouth. Current available clinical literature on this subject is incomplete. PURPOSE: The purpose of this study is to investigate the clinical outcome of the immediate loading of Brånemark System implants (Nobel Biocare AB, Gothenburg, Sweden) inserted with enhanced initial stability principally in posterior sites (78%). MATERIALS AND METHODS: The present study was conducted in 26 consecutively treated patients. A total of 50 Brånemark System machined surface implants were placed supporting 30 fixed temporary partial dentures in light occlusion. All implants were followed up for a minimum of 1 year of function. Minimum requirements for immediate loading were proposed. Bone quality and quantity were classified according to Lekholm and Zarb's criteria. Stability of the marginal bone level, both mesial and distal, was measured on the basis of radiographic analysis. Implant survival rate was calculated according to Kaplan-Meier analysis. The peak insertion torque employed during fixture placement was between 40 and 72 Ncm, except in the case of one implant that was lost. RESULTS: Overall survival rate was 98%. An unpaired t-test revealed bone remodeling conforming to biologic width establishment (p <.005). CONCLUSIONS: Within the limit of this study, immediate loading appears to be a viable procedure in posterior sites and for a growing number of clinical indications. Enhanced implant stability and light occlusion seem to be security factors. In spite of unfavorable conditions such as the presence of quality 4 bone and a lack of splinting, all implants with enhanced primary stability survived.

Adult↗

Immediate loading of 190 endosseous dental implants: a prospective observational study of 40 patient treatments with up to 2-year data.

PURPOSE: The present study was undertaken to determine the feasibility of using primary stability as a predictor of implant success in patients whose implants were immediately loaded. MATERIALS AND METHODS: The study included 40 patients, in whom a total of 190 implants were placed, 102 in maxillary sites and 88 in mandibular sites. All were loaded within 72 hours of placement. Sixteen patients were completely edentulous in the mandible and/or the maxilla. The remaining 24, who were partially edentulous, received fixed partial dentures or single-implant restorations. All of the definitive implant restorations were screw retained. The criterion for loading was clinical judgment of primary stability, verified by a "screw test." Impressions were made after implant placement to facilitate the fabrication of a laboratory-made heat-processed provisional restoration from acrylic resin. Following a 4-month period for osseointegration and soft tissue healing, definitive fixed prostheses were fabricated. RESULTS: There were no surgical complications. After 1 to 2 years, all 190 implants had survived and were considered 100% successful, as determined by independent testing of mobility and radiographic evidence of osseointegration. In 4 patients, fracture of the provisional restoration occurred during the healing period. DISCUSSION: Clinical research has shown that immediate loading is a viable treatment modality. The favorable success rate reported in this study for rough-surfaced implants suggests that adherence to a protocol, an important parameter of which is primary stability above 32 Ncm, can lead to osseointegration. CONCLUSION: The results of this limited investigation suggest that patients who are partially or completely edentulous may be immediately restored with implants and fixed provisional restorations, provided that the dental implants are adequately stable immediately after their surgical placement. This alternative therapeutic approach did not appear to affect the up-to-2-year survival of the implants in this patient population.

Adolescent↗

Immediate occlusal loading of Brånemark System TiUnite implants placed predominantly in soft bone: 4-year results of a prospective clinical study.

BACKGROUND: Immediate occlusal implant loading has been documented as a viable treatment option for various indications. However, most of the available studies reported on the short-term outcome of this treatment modality. PURPOSE: The purpose of this prospective clinical study was to document, on a long-term basis, the outcome of immediate occlusally loaded Brånemark System Mk IV TiUnite (Nobel Biocare AB, Göteborg, Sweden) implants placed to support fixed reconstructions in various regions of the jaws. MATERIALS AND METHODS: Thirty-eight patients received a total of 51 fixed prosthetic reconstructions, all of which were connected on the day of implant insertion. Twenty restorations replaced single teeth, 30 were fixed partial dentures, and 1 was a full-arch fixed lower restoration. These prostheses were supported by 102 Brånemark System Mk IV TiUnite implants (38 maxillary and 64 mandibular), the majority of which were placed in posterior regions (88%) and mainly in soft bone (76%). Resonance frequency measurements and marginal periimplant soft tissue evaluations were conducted during the course of the study. Furthermore, radiographic examinations were performed at the time of prosthesis delivery and at the 1- and 6-month and 1-, 2-, 3-, and 4-year follow-up visits. This report summarizes the results after 4 years of loading. RESULTS: Three maxillary implants were removed, although stable, in one patient at the 8-week follow-up owing to postoperative infection in the adjacent guided bone regeneration area. No implants were lost further on. This resulted in a cumulative implant success rate of 97.1% after 4 years of prosthetic loading. The mean marginal bone remodeling after 4 years of function was 1.3 +/- SD 0.9 mm. At 4 years, absence of marginal plaque and bleeding on probing was reported for 87% and 69% of the sites, respectively, thereby remaining unchanged since the 1-year follow-up. On average, the interproximal soft tissue fill increased for both mesial and distal papillae from scores of 1.4 +/- 1.1 and 1.0 +/- 1.1, respectively, at the preoperative assessment to 2.0 +/- 0.8 and 1.7 +/- 0.8, respectively, at the 4-year assessment. CONCLUSION: The applied immediate loading protocol, in combination with a slightly tapered implant design and a modified implant surface texture, was shown to be a successful treatment alternative in regions exhibiting soft bone.

Adult↗

[Immediate loading of dental implants in partialful edentulous and edentulous jaws].

OBJECTIVE: To investigate the clinical feasibility and technical characteristics of immediate loading and to access the short-term clinical results of treatment. METHODS: This study included 3 completely edentulous patients and 24 patients who were partially edentulous from March 1999 to December 2003. 21 implants were immediately loaded and provided support for mandibular overdenture for 3 fully edentulous patients. 30 implants were placed in 21 partially edentulous patients and implants were immediate loaded in edentulous mandibular providing support for fixed provisional prosthesis within 6 months. Then, metal-ceramic crowns were completed. All patients were followed up by 1, 3, 6, 12 months and the patients were checked every 12 months. RESULTS: A total of 42 implants were loaded immediately. From March 1999 to December 2003, no implants were lost during follow-up (range 3 to 49 months, mean of 28 months). No infections, nerve or sinus damage or other sequelae occurred. No implants exhibited peri-implant radiolucencies. Moreover, immediate loading seems to increase the ossification of the alveolar bone around endosseous implants. Patients were satisfied with the treatment. CONCLUSIONS: The data and the experience described in this study indicate that immediate loading with restorations using appropriate surgical and restorative techniques can predicate the completely edentulous and partially edentulous mandible in some cases. Further study is needed to determine the long-term result of immediately loaded implants.

Adult↗

Immediate restoration and loading of dental implants: clinical considerations and protocols.

The use of dental implants to assist in the treatment of partial and complete edentulism is well documented. Most of the implant literature, however, reports results associated with implant survival and success when there has been adherence to rigid placement and loading protocols. Conventionally, these protocols call for the undisturbed healing of the implant-3 months in the mandible and 4 to 6 months in the maxilla. This article evaluates the literature and develops protocols for clinical procedures for the early or immediate restoration or loading of dental implants. Criteria are established for defining immediate loading, immediate restoration, early loading, and early restoration as compared to conventional protocols. The review assesses factors that influence accelerated loading and restoration decisions, including bone quality and quantity, implant design, splinting of implants, and prosthetic design. Conclusions and recommendations are made based on the experience of the consensus group charged with considering these procedures and on the current literature published on these protocols.

Bone Density↗

Simplified treatment of the atrophic posterior maxilla via immediate/early function and tilted implants: A prospective 1-year clinical study.

BACKGROUND: Posterior maxillae are often difficult to treat owing to the sinus antrum. Placing implants in remaining bone regions in the atrophic maxilla, without performing sinus grafting, is a challenge. Immediate function adds to this challenge. PURPOSE: The purpose of this study was to suggest and evaluate a simplified treatment concept for the rehabilitation of the atrophic maxilla using tilted implants subjected to immediate/early function. MATERIALS AND METHODS: Eighteen patients were included in the study. Sixty implants were placed to support 19 fixed partial or full-arch prostheses. Immediate/early function was applied. The patients were followed for a minimum of 1 year after prosthesis connection. Stability measurements and radiographic evaluation of the change of the marginal bone level were performed. RESULTS: One axial and one tilted implant failed in one patient, giving a cumulative survival rate of 96.7%. No failure of provisional prostheses occurred. The mean marginal bone resorption recorded after 1 year was low (0.82 mm for axial implants and 0.34 mm for tilted implants). CONCLUSION: The results of the present study suggest that tilted implants placed in immediate function may be a viable treatment approach for the rehabilitation of the atrophied maxilla. Simplified treatment procedures, reduced surgical invasion, shorter treatment time, and reduced costs constitute some of the benefits for the patient and the clinician.

Aged↗

Dental root agenesis secondary to irradiation therapy in a case of rhabdomyosarcoma of the middle ear.

There have been only a few published reports on the dental-facial effects of radiation therapy and the subsequent oral management of these patients. A case involving a 13-year-old black male patient with a history of rhabdomyosarcoma is presented. The patient received 4,050 rads of radiation to the right middle ear when he was 2 years of age. His residual medical and dental difficulties are apparently complications from the initial therapy. Examination of the oral cavity revealed bimaxillary micrognathia and marked loss of vertical dimension. A Class II facial profile with Class I molar relationship was observed. The mandible was thin and hypoplastic, with a small knife-edge alveolar ridge. The remaining eighteen erupted permanent teeth were very mobile, and root development had ceased after only initial formation. All of the teeth except the first permanent molars were extracted, and immediate partial dentures were inserted at the time of surgery. A discussion of therapeutic considerations follows the case report.

Abnormalities, Radiation-Induced↗

Critical review of immediate implant loading.

BACKGROUND: Implant dentistry has become successful with the discovery of the biological properties of titanium. In the original protocol, studies have advocated a 2-stage surgical protocol for load-free and submerged healing to ensure predictable osseointegration. However, the discomfort, inconvenience, and anxiety associated with waiting period remains a challenge to both patients and clinicians. Hence, loading implant right after placement was attempted and has gained popularity among clinicians. Issues/questions related to this approach remain unanswered. Therefore, it is the purpose of this review article to (1). review and analyze critically the current available literature in the field of immediate implant loading and (2). discuss, based on scientific evidence, factors that may influence this treatment modality. MATERIAL AND METHODS: Literature published over the past 20 years was selected and reviewed. Findings from these studies were discussed and summarized in the tables. The advantages and disadvantages associated with immediate implant loading were analyzed. Factors that may influence the success of immediate implant loading, including patient selection, type of bone quality, required implant length, micro- and macrostructure of the implant, surgical skill, need for achieving primary stability/control of occlusal force, and prosthesis guidelines, were thoroughly reviewed and discussed. RESULTS AND CONCLUSION: Various studies have demonstrated the feasibility and predictability of this technique. However, most of these articles are based on retrospective data or uncontrolled cases. Randomized, prospective, parallel-armed longitudinal human trials are primarily based on short-term results and long-term follow-ups are still scarce in this field. Nonetheless, from available literature, it may be concluded that anatomic locations, implant designs, and restricted prosthetic guidelines are key to ensure successful outcomes. Future studies, preferably randomized, prospective longitudinal studies, are certainly needed before this approach can be widely used.

Bite Force↗

Immediate/early loading of dental implants: a report from the Sociedad Española de Implantes World Congress consensus meeting in Barcelona, Spain, 2002.

BACKGROUND: Immediate/early loading protocols are becoming frequently used in implant dentistry, but the prerequisites for achieving good results and the limitations of such protocols are not fully known. Moreover, the terminology used in immediate/early loading is still confusing. PURPOSE: The purpose of this article is to present the outcome of a consensus meeting on immediate/early loading. MATERIALS AND METHODS: A consensus meeting was organized during the Sociedad Española de Implantes World Congress in Barcelona on May 23, 2002, with the objective to present and discuss the experiences from immediate/early loading protocols in dental implant treatment. The purpose was also to discuss definitions of the terminology used in immediate/early loading. The consensus meeting agenda included presentations from invited experts, followed by a consensus discussion. RESULTS: A consensus statement was agreed on. CONCLUSIONS: Multiple independent investigators have demonstrated that immediate/early loading of implants is possible in many clinical situations; however, additional documentation is required.

Dental Implantation, Endosseous↗