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: 1.49). 01/2009; 24 Suppl:132-46.
Source: PubMed

ABSTRACT 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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    • "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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    • "Based on the articles in which an observation period ranged from 1 to 10 years, the survival rates of the implants which supported the overdentures in the mandible, ranged from 91.7% to 100%, and the mean implant survival rate was over 98%, both of which supports the presumption that this treatment has a good prognosis in a long-term perspective. This high implant survival rate was coincident with the result of previous reports which showed an implant survival rate of more than 97.2% for mandibular fixed prosthesis and more than 97.1% for mandibular overdentures.33 Four studies11-14 presenting data on implant survival according to attachment systems, did not specify censored data for a cumulative survival rate making it impossible to calculate an implant survival rate according to different attachment systems through meta-analysis. "
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    ABSTRACT: The aim of this systematic review was to address treatment outcome according to attachment systems for mandibular implant overdentures in terms of implant survival rate, prosthetic maintenance and complications, and patient satisfaction. A systematic literature search was conducted using PubMed and hand searching of relevant journals considering inclusion and exclusion criteria. Clinical trial studies on mandibular implant overdentures until August, 2010 were selected if more than one type of overdenture attachment was reported. Twenty four studies from 1098 studies were finally included and the data on implant survival rate, prosthetic maintenance and complications, patient satisfaction were analyzed relative to attachment systems. Four studies presented implant survival rates (95.8 - 97.5% for bar, 96.2 - 100% for ball, 91.7% for magnet) according to attachment system. Ten other studies presented an implant survival rate ranging from 93.3% to 100% without respect to the attachment groups. Common prosthetic maintenance and complications were replacement of an assay for magnet attachments, and activation of a matrix or clip for ball or bar attachments. Prosthetic maintenance and complications most commonly occurred in the magnet groups. Conflicting findings were found on the rate of prosthetic maintenance and complications comparing ball and bar attachments. Most studies showed no significant differences in patient satisfaction depending upon attachment systems. The implant survival rate of mandibular overdentures seemed to be high regardless attachment systems. The prosthetic maintenance and complications may be influenced by attachment systems. However patient satisfaction may be independent of the attachment system.
    The journal of advanced prosthodontics 11/2012; 4(4):197-203. DOI:10.4047/jap.2012.4.4.197 · 0.63 Impact Factor
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    • "This is of paramount importance when it comes to selecting a treatment plan. Only a few of the currently used protocols have been assessed with comprehensive success criteria and therefore can be considered to have some degree of scientific or clinical validation (Gallucci et al., 2009b). "
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    ABSTRACT: The purpose of this study was to examine the most frequently used criteria to define treatment success in implant dentistry. An electronic MEDLINE/PubMED search was conducted to identify randomized controlled trials and prospective studies reporting on outcomes of implant dentistry. Only studies conducted with roughened surface implants and at least five-year follow-up were included. Data were analyzed for success at the implant level, peri-implant soft tissue, prosthetics, and patient satisfaction. Most frequently reported criteria for success at the implant level were mobility, pain, radiolucency, and peri-implant bone loss (> 1.5 mm), and for success at the peri-implant soft-tissue level, suppuration, and bleeding. The criteria for success at the prosthetic level were the occurrence of technical complications/prosthetic maintenance, adequate function, and esthetics during the five-year period. The criteria at patient satisfaction level were discomfort and paresthesia, satisfaction with appearance, and ability to chew/taste. Success in implant dentistry should ideally evaluate a long-term primary outcome of an implant-prosthetic complex as a whole.
    Journal of dental research 12/2011; 91(3):242-8. DOI:10.1177/0022034511431252 · 4.14 Impact Factor
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