Abstract
Background: The aim of this systematic review was to evaluate the survival rates of immediately loaded implants after at least five years. Besides implant failure, the amount of marginal bone loss around implants and the complication type were assessed. Methods: The electronic search was undertaken on Medline, Scopus, and Cochrane Central Register of Controlled Trials using key terms such as: “immediate loading”, “immediate function”, “immediate restoration”, “immediate temporization”, “dental implants”, “fully edentulous patients”, “partially edentulous patients”. The search terms were combined using the Boolean operators AND, OR. The last electronic search was performed on 15 February 2018. Two authors independently screened the studies, extracted the data, and assessed the risk-of bias. The main outcomes recorded for each study were: implant and prosthesis success and survival, marginal bone level change, incidence and type of complications. Kaplan–Meier analysis was used to estimate cumulative survival rates. Results: Thirty-four prospective studies with at least five-year follow-up, published between 2007 and 2017 were included. A total of 5349 immediately loaded implants in 1738 patients were analyzed. The mean follow-up was 72.4 months (median 60 months, 95% confidence intervals (CI): 64.53, 80.25 months, range 60 to 147 months). The mean weighted implant survival was 97.4% (median 98.15%, 95% CI: 96.29%, 98.54%, range 83.80% to 100%). Cumulative survival rate of implants placed in the mandible was significantly higher than for the maxilla (p < 0.01). No significant difference in failure rate was found among the types of prosthesis employed (p = 0.27). The mean peri-implant bone level change at the end of the follow-up in each study ranged from 0.3 to 1.7 mm. Conclusion: Immediate loading of implants appears to have long-term predictability and success rate under well-defined circumstances.
Highlights
The original Brånemark protocol for placing dental implants required a two-stage surgery with a submerged healing period of at least three months in the mandible and six months in the maxilla, allowing the implant to osseointegrate without exposure to external trauma [1]
The present review aimed at evaluating the prognosis of immediate loading, independent of comparison with conventional delayed loading, which has a well-established prognosis
The PICO question was: “In partially and fully edentulous patients, what are the implant and prosthesis survival rates, the incidence of complications and the marginal bone level changes after a minimum of five years in patients treated with immediately loaded implants, reported by prospective clinical trials?”
Summary
The original Brånemark protocol for placing dental implants required a two-stage surgery with a submerged healing period of at least three months in the mandible and six months in the maxilla, allowing the implant to osseointegrate without exposure to external trauma [1]. In 1977 Sarmiento et al provided convincing experimental evidence that early weight-bearing can accelerate the process of fracture healing [6], findings which hint at the role of the immediately loaded implants’ integration. This was in accordance with results of an earlier study by Hulbert et al in 1974, which compared bone ingrowth in implants inserted in a weight-bearing femur and in a load-free amputated femur [7]. Conclusion: Immediate loading of implants appears to have long-term predictability and success rate under well-defined circumstances
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