Loading protocols for dental implants in edentulous patients

Department of Restorative Dentistry and Biomaterials Science, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, Massachusetts 02115, USA.
The International journal of oral & maxillofacial implants (Impact Factor: 1.45). 01/2009; 24 Suppl:132-46.
Source: PubMed


The objective of this systematic review was to present the current scientific and clinical evidence related to implant-supported rehabilitations for the edentulous mandible and maxilla.
An electronic search of several databases covered the period from January 1966 to August 2008. From a total of 2,371 publications identified from this search, 61 articles fulfilled the inclusion criteria set forth by the authors. It should be noted that only studies reporting on implants with rough surfaces were included in the final selection for this review.
Selected studies yielded data from 2,278 patients and 9,701 implants. Studies were grouped according to treatment protocol and prosthodontic design, and results on conventional, early, and immediate loading were assessed separately for fixed and removable dental prostheses. Clinical recommendations for implant loading in different edentulous indications were established using a special validation protocol of the published scientific and clinical evidence for different treatment modalities, which was based on the study design, sample size, and outcome homogeneity between studies.
The highest level of scientific and clinical validation was found for conventional loading with mandibular overdentures and maxillary fixed dental prostheses. Insufficient scientific or clinical documentation/validation was found for immediate loading of maxillary overdentures, as well as for immediate loading of immediately placed implants combined with fixed or removable dental prostheses in either jaw. All other loading protocols for edentulous arches showed different degrees of clinical documentation.

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    • "Despite new advancements and improvements of the commercially available implants, the conventionally recommended healing period during which implants should remain unloaded is 2–6 months. According to the latest reviews, shortening of this preloading time increases the failure rate by 2-to 3-fold, especially for unsplinted implants (Tawse-Smith et al. 2002; Esposito et al. 2009; Gallucci et al. 2009). Indeed, some prerequisites are necessary for an immediate loading of dental implants, such as primary clinical stability and adequate splinting. "
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    ABSTRACT: In the present study, a new healing cap that could generate a pulsed electromagnetic field (PEMF) around titanium implants to stimulate peri-implant osteogenesis was tested in the rabbit model. A total of 22 implants were inserted in the proximal tibial metaphysis of 22 rabbits. A healing cap containing the active device was inserted in half of the implants (11 test implants); an "empty" healing cap was inserted in the other ones (11 control implants). The animals were euthanized after 2 and 4 weeks, and the samples were processed for micro-computed tomography and histology. The peri-implant volume was divided into coronal (where the PEMF was the strongest) and apical regions. Most of the effects of the tested device were confined to the coronal region. Two weeks post-implantation, test implants showed a significant 56% higher trabecular bone fraction (BV/TV), associated with enhanced trabecular number (Tb.N, +37%) and connectivity density (Conn.D, +73%) as compared to the control group; at 4 weeks, the PEMF induced a 69% increase in BV/TV and 34% increase of Tb.N. There was no difference in the trabecular thickness (Tb.Th) at either time point. Furthermore, we observed a 48% higher bone-to-implant contact (BIC) in the test implants vs. controls after 2 weeks; this increase tended to remain stable until the fourth week. Mature trabecular and woven bone were observed in direct contact with the implant surface with no gaps or connective tissue at the bone-implant interface. These results indicate that the PEMF device stimulated early bone formation around dental implants resulting in higher peri-implant BIC and bone mass already after 2 weeks which suggests an acceleration of the osseointegration process by more than three times. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    Clinical Oral Implants Research 08/2015; DOI:10.1111/clr.12661 · 3.89 Impact Factor
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    • "The surgical and prosthetic protocols have been developed in order to reduce the time between surgery and the installation of the prosthesis [5]. In addition, this treatment protocol has showed success rates similar to the treatments performed conventionally [3] [4] [5]. This case report presents a technique option to the fast confection of metal framework for the treatment of total edentulous patients when planning the implant-supported prostheses with immediate loading. "
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    ABSTRACT: The oral rehabilitation of edentulous patients with immediate loading has become a safe procedure with high predictability. The success is related to immediate fabrication of a passive fit framework to attach the implants. Based on these considerations, this case report shows an alternative technique for mandibular rehabilitation using implants immediately loaded, where the framework was fabricated using cylinders with internal reinforcement and precast pieces, electrowelding, and conventional welding providing esthetics and function to the patient in a short period of time.
    01/2015; 2015:102189. DOI:10.1155/2015/102189
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    • "The oral rehabilitation of edentulous patients has been improved by the use of dental implants (Branemark et al., 1977; Gallucci et al., 2009a) using fixed and removable prosthesis (Akca et al., 2007; Ekelund et al., 2003). The use of two or four implants to retain mandibular overdentures has been indicated with similar clinical and radiographic outcomes (Batenburg et al., 1998; Visser et al., 2005). "
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    ABSTRACT: A finite element analysis was used to compare the effect of different designs of implant-retained overdentures and fixed full-arch implant-supported prosthesis on stress distribution in edentulous mandible. Four models of an human mandible were constructed. In the OR (O'ring) group, the mandible was restored with an overdenture retained by four unsplinted implants with O'ring attachment; in the BC (bar-clip) -C and BC groups, the mandibles were restored with overdentures retained by four splinted implants with bar-clip anchor associated or not with two distally placed cantilevers, respectively; in the FD (fixed denture) group, the mandible was restored with a fixed full-arch four-implant-supported prosthesis. Models were supported by the masticatory muscles and temporomandibular joints. A 100-N oblique load was applied on the left first molar. Von Mises (σvM), maximum (σmax) and minimum (σmin) principal stresses (in MPa) analyses were obtained. BC-C group exhibited the highest stress values (σvM=398.8, σmax=580.5 and σmin=-455.2) while FD group showed the lowest one (σvM=128.9, σmax=185.9 and σmin=-172.1). Within overdenture groups, the use of unsplinted implants reduced the stress level in the implant/prosthetic components (59.4% for σvM, 66.2% for σmax and 57.7% for σmin versus BC-C group) and supporting tissues (maximum stress reduction of 72% and 79.5% for σmax, and 15.7% and 85.7% for σmin on the cortical and trabecular bones, respectively). Cortical bone exhibited greater stress concentration than the trabecular bone for all groups. The use of fixed implant dentures and removable dentures retained by unsplinted implants to rehabilitate edentulous mandible reduced the stresses in the periimplant bone tissue, mucosa and implant/prosthetic components.
    Journal of Biomechanics 03/2013; 46(7). DOI:10.1016/j.jbiomech.2013.02.008 · 2.75 Impact Factor
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