Conventionally Loaded Research Articles

No difference between failure rates of early and conventionally loaded implants

The Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, 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of all identified trials, an internet discussion group and 55 dental implant manufacturers were contacted to find unpublished randomised controlled trials (RCT). RCT were selected of root-form osseo-integrated oral implants that had a followup of 6 months-1 year and which compared the same osseo-integrated root-form implants immediately (within 1 week), early (1 week-2 months) and conventionally loaded (after 2 months), giving the following outcome measures: failures, implant failures and marginal bone levels on intra-oral radiographs. 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 Oral Health Group's statistical guidelines were followed. Twenty RCT were identified and 11 trials comprising a total of 300 patients were included. Six trials compared immediate versus conventional loading, three early versus conventional loading and two immediate versus early loading. On a patient, rather than per implant basis, there were no statistically significant differences for any of the meta-analyses. It is possible to successfully load dental implants immediately or early after their placement in selected patients, but not all clinicians achieve optimal results when loading the implant immediately. 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 RCT are needed. Priority should be given to trials comparing immediately versus early loaded implants to improve patient satisfaction and decrease treatment time and trials should be reported according to the CONSORT guidelines (http://www.consort-statement.org/).

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

The aim of this prospective clinical study was to evaluate the clinical outcomes of dental implants placed in the mandibular molar sites and immediately functionally restored compared with conventionally loaded controls in an in-patient study. Twenty-four dental implants were placed in 12 patients who had first molar loss bilaterally in the mandibular area. One site of the patient was determined as immediately loaded (IL) and the other side was conventionally loaded (CL). Resonance frequency analyses for implant stability measurements, radiographic examinations for marginal bone levels and peri-implant evaluations were performed during the clinical follow-up appointments within 12 months. During the 12-month follow-up period, only one implant was lost in the IL group. The mean implant stability quotient values were 74.18+/-5.72 and 75.18+/-3.51 for Groups IL and CL at surgery, respectively, and the corresponding values were 75.36+/-5.88 and 75.64+/-4.84 at 1-year recall, respectively. The difference was not statistically significant between the two groups during the 12-month study period (P>0.05). When peri-implant parameters were evaluated, excellent peri-implant health was demonstrated during the 1-year observation period and all implants showed less than 1 mm of marginal bone resorption during the first year. In the present study, immediate functionally loading did not negatively affect implant stability, marginal bone levels and peri-implant health when compared with conventional loading of single-tooth implants.

The Impact of Prosthetic Design on the Stability, Marginal Bone Loss, Peri‐Implant Sulcus Fluid Volume, and Nitric Oxide Metabolism of Conventionally Loaded Endosseous Dental Implants: A 12‐Month Clinical Study

Further clarification of the early and late response of peri-implant tissues to surgical insertion and loading of dental implants and the potential associations among the various implant-related measures are likely to improve the evaluation/monitoring of implant sites. Thus, analyses were made of the volume and nitric oxide (NO) profile of peri-implant sulcus fluid (PISF), implant stability, and marginal bone level in relation to different prosthetic designs. Seven totally edentulous subjects and 11 partially edentulous subjects were included. Resonance frequency analysis (RFA), marginal bone level measurements, PISF volume, and spectrophotometrically determined nitrite levels were analyzed comparatively at conventionally loaded (CL) implant sites and at implants with removable prostheses (RP; N = 14) and fixed prostheses (FP; N = 11) for a period of 12 months. At implant sites with RP, PISF volume decreased gradually and its lowest level occurred at the end of the experimental period. The PISF nitrite content increased until 6 months and was followed by a significant decrease at 12 months. Compared to baseline, RFA values exhibited a significant decrease at 1 and 3 months. Marginal bone level was significantly lower at all follow-up visits compared to baseline. More volumetric fluctuations of PISF was noted at implant sites with FP. The PISF nitrite content had decreased, compared to baseline, at 6, 9, and 12 months. A general stability was observed for RFA. The marginal bone loss observed at 6 months was followed by a gain at 12 months. An inverse relationship was noted between RFA values and marginal bone levels. The prosthetic design particularly seems to affect the NO metabolism around CL implants, whereas it does not seem to have any impact on the stability of dental implants.

Effect of loading time on the success of complete mandibular titanium implant retained overdentures: a systematic review

The aim of this review was to compare conventional against early/immediate loading protocols of implant-retained overdentures (IOD) in the edentulous mandible. Medline search via Ovid to extract prospective comparative studies on trials comparing the effect of timing of loading initiation on the success of mandibular IOD. The outcome of major interest was marginal bone loss. Probing depth, plaque, bleeding index and mobility were also assessed. Indices at 12 and 24 months were compared and changes assessed. Outcomes were entered into RevMan (version 4.2.5) for meta-analysis. Of 239 articles, only nine trials fulfilled the criteria and involved 30 immediate, 71 early, 77 one-stage conventional, and 66 two-stage conventional subjects. Three immediate loading trials showed an increase in the amount of marginal bone loss over time, while the majority of early and conventionally loaded implants exhibited a decrease in the amount of bone loss in the second year compared with the first 12-month period. Probing depth at 24 months showed a significant difference between early and conventional loading; SMD 0.5 (95% confidence interval 0.03, 0.97). No other statistically significant differences were found between either immediate or early and conventional loading for any indices. No deleterious effects up to 24 months have been shown from immediate or early loading. Conventional loading after a 3-month healing period has not been proven to be the only acceptable protocol for mandibular IOD, but further long-term studies are needed to confirm this.

Indications for immediate loading of implants and implant success

It was the aim of this review to compare the survival and success rates of immediately loaded dental implants with those of conventionally loaded dental implants, based on prospective controlled studies and prospective studies without controls. Studies on immediate loading were identified in the current literature by electronic and hand searches. Only clinical data on root-form or cylindrical threaded oral implants were included. For immediate loading of oral implants in the edentulous and partially dentate, mandible and maxilla controlled studies could be found. All of these studies were based on limited patient numbers. Therefore, definitive conclusions could not be drawn concerning survival and success rates of immediately loaded implants compared with conventionally loaded implants. The compilation of the current literature shows that prospective controlled studies as well as prospective studies without controls using several different approaches to immediate loading have demonstrated high implant survival and success rates. However, more high-level evidence-based studies are needed to demonstrate the relative merits of immediate loading compared with conventional loading in all potential applications.