Implant loading protocols for the partially edentulous Esthetic zone
ABSTRACT The scientific evidence related to different or novel implant loading (primary objective) and directly associated implant placement (secondary objective) protocols developed for the anterior maxillae of partially edentulous patients was reviewed.
A comprehensive search of electronic databases and a hand search of six relevant journals was performed. The principal outcome variables were implant survival, implant success, and esthetic appearance. Concerning esthetic treatment outcomes, articles were specifically screened for the presence of objective evaluation parameters and patient satisfaction assessment.
The analysis of the literature on immediately restored or conventionally loaded implants in the esthetic zone revealed an initial survival rate of 97.3% after 1 year (10 prospective cohort studies and one case series). For periods of 1 to 5 years, the survival rate was 96.7%. These survival rates are consistent with previous reports on more traditional loading modalities. However, for immediately placed implants with immediate restoration and occlusal loading, the survival rate dropped by approximately 10% (four studies). Success criteria such as stable crestal bone levels, soft tissue recession, and probing depth could not be evaluated on the basis of the available literature.
There is a paucity of prospective cohort studies addressing patient-centered outcomes. No parameters specific to immediate loading protocols were available for evaluation. In order to validate or reject such implant protocols for use in the esthetically sensitive anterior maxilla, long-term clinical trials should routinely include objective esthetic criteria that comprehensively embrace the pertinent elements of "pink and white esthetics" in the form of readily used indices.
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ABSTRACT: Purpose: This 1-year randomized clinical trial compared the bone regeneration and success rates between immediate and conventional loading of dental implants placed immediately after extraction in patients with a past history of periodontal disease.Methods: Sixty patients who chose an immediate implant treatment option to replace a hopeless tooth were included in this study.Patients: Patients were randomly assigned to receive immediate implants with either immediate loading (group A) or conventional loading after 3 months (group B). At baseline, both groups received a mucoperiosteal flap, extraction, implant placement, allograft bone, and a membrane. Group A received a provisional crown. In group B, a cover screw was placed and primary closure was achieved. The patients were evaluated at 3, 6, and 12 months postoperatively.Results: The 1-year implant survival rate was 95% for the whole study group: 96.6% for group A, and 93.3% for group B. The bone level increased significantly in both groups (group A: 0.99 ± 0.22 mm; group B: 0.75 ± 0.17 mm), and the difference was not statistically significant (p > 0.5). At the 1-year postoperative visit, the mucogingival junction (MGJ) was found to be displaced coronally in 65% of implant sites in group B compared with 15% sites in group A.Conclusions: Both the immediate and delayed loading of immediately placed implants showed similar outcome with regards to treatment success rates and stability of radiographic bone level. Submerging an immediately placed implant and primary soft tissue closure did not show significant outcome advantages over the transmucosal approach.Clinical Implant Dentistry and Related Research 10/2010; 14(5). DOI:10.1111/j.1708-8208.2010.00310.x · 2.80 Impact Factor
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ABSTRACT: this study compared the outcome of immediate non-occlusal loading with conventional loading for single implants in the maxillary aesthetic zone. It was hypothesized that immediate non-occlusal loading is not inferior to conventional loading. sixty-two patients with a missing maxillary anterior tooth were randomly assigned to be treated with an implant that was either restored with a non-occluding temporary crown within 24 h after implant placement (the "immediate group") or was restored according to a two-stage procedure after 3 months (the "conventional group"). All implants were installed in healed sites. Follow-up visits were conducted after 6 and 18 months post-implant placement. Outcome measures were radiographic marginal bone-level changes, survival, soft tissue aspects (probing depth, plaque, bleeding, soft tissue level), aesthetics and patient satisfaction. no significant differences were found between both study groups regarding marginal bone loss (immediate group 0.91 ± 0.61 mm, conventional group 0.90 ± 0.57 mm), survival (immediate group 96.8%: one implant lost, conventional group 100%), soft tissue aspects, aesthetic outcome and patient satisfaction. within the limitations of this study (sample size, follow-up duration), it was demonstrated that, for single implants in the anterior maxilla, the outcome of immediate non-occlusal loading was not less favourable than conventional loading.Journal Of Clinical Periodontology 11/2010; 38(2):186-94. DOI:10.1111/j.1600-051X.2010.01650.x · 3.61 Impact Factor
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ABSTRACT: This 2-year randomized clinical trial compared bone regeneration and esthetic outcome between immediate and conventional loading of dental implants placed immediately after extraction in patients with a history of periodontal disease. Patients were randomly assigned to receive immediate implants with either immediate loading or conventional loading after 3 months. Both groups received a periodontal flap, tooth extraction, implant placement, allograft bone, and membrane placement. The immediate loading group received a temporary crown. In the conventional loading group primary closure was achieved. All patients were followed up at 3, 6, 12, and 24 months. Evaluation included radiographic bone changes, papillary esthetic outcome, and implant survival rate. Seventy-two patients were recruited into the study. However, 60 patients received immediate implant placement after extraction: 30 with conventional loading and 30 with immediate loading. In the immediate loading group the implant survival rate at 2 years was 96.7%, and the mean bone gain was 1.19 mm. The corresponding figures in the conventional loading group were 93.3% and 1 mm. The gain in bone level occurred mainly from baseline to 1 year postoperatively in both groups (P <0.001). The papilla index decreased from baseline to 1 year in both groups (P <0.001) and changed only slightly thereafter. There were no significant differences between the two groups in the amount of bone gain or papilla index change during 2 years. Immediate loading of a single implant placed in a fresh extraction site in periodontally compromised patients resulted in similar bone gain and soft tissue esthetic outcomes compared to delayed loading. Primary closure and delayed loading to ensure bone regeneration around implants were not critical in this study.Journal of Periodontology 12/2010; 81(12):1743-51. DOI:10.1902/jop.2010.100162 · 2.57 Impact Factor