Abstract
Introduction: In recent years, the immediate loading procedure for the rehabilitation of edentulous jaws has gained popularity among patients and practitioners. The purpose of this study was to evaluate implant and prosthetic success rates for the rehabilitation of edentulous maxillae using tilted distal implants and immediate loading of prostheses, after 2 years. Material and method: Patients included in the study received a complete prosthesis of the upper arch, attached to 4, 5 or 6 implants. The provisional prosthesis was fixed the same day the implants were placed. After a period of osseointegration, the provisional prosthesis was replaced by a definitive prosthesis with a titanium framework made using computer-aided design/computer-assisted manufacturing (CAD/CAM) technology. Judgment criteria were the implant success rate, the provisional prosthesis success rate, and the definitive prosthetic success rate. Results: Two hundred and forty-two implants were placed in 48 patients. Five implants were lost, resulting in an implant survival at 2 years of 97.9%. Two provisional fixed prosthesis had to be temporarily replaced by a removable solution, resulting in a provisional prosthesis success rate of 95.8%. The definitive prosthesis success rate was 100%. Discussion: Use of a provisional prosthesis during the osseointegration period is essential, both for the preparation of the final prosthesis as well as for proper management of potential implant failures. Implant failures are more easily managed if at least five implants were originally placed.
Highlights
Immediate loading of supra-implanted total prosthesis, defined in 2014 by the Fifth Consensus Conference of the ITI (International Team for Implantology) as the occlusion within a maximum period of 7 days after the placement of the implants [1], has become a standard solution for the rehabilitation of the toothless arcades, both in the mandible and in the maxilla. It provides the advantage of offering quick, comfortable aesthetic and functional restoration to the patient. It ensures strong retention between implants, limiting the amplitude of the micromovements to the bone–implant interface below the critical threshold for osseointegration [2] and decreasing the constraints transferred to the surrounding bone [3]
The patients included had received between June 2007 and June 2013 the placement of 4–6 maxillary implants, with immediate loading of a provisional prosthesis fixed on the day of surgery, followed by the implementation of the final prosthesis in titanium fabricated by computer-aided design and computer-aided manufacturing (CAD/CAM) after an osseointegration period of the implants
The study confirms the excellent results achieved with the protocols of immediate loading of prostheses supported by a combination of 4–6 axial and angulated implants
Summary
Immediate loading of supra-implanted total prosthesis, defined in 2014 by the Fifth Consensus Conference of the ITI (International Team for Implantology) as the occlusion within a maximum period of 7 days after the placement of the implants [1], has become a standard solution for the rehabilitation of the toothless arcades, both in the mandible and in the maxilla It provides the advantage of offering quick, comfortable aesthetic and functional restoration to the patient. Placed at the level of the anterior wall of the sinus, where the bone is generally dense, these implants can be longer, which provides them with better bone anchoring Their tilt allows to increase the distance between the pillars implant mesial and distal abutments, decreasing the length of the prosthetic cantilever to achieve better distribution of occlusal forces [17]
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