Initial stability of the implant is one of the fundamental criteria for obtaining osseointegration. An adequate primary anchorage is often difficult to achieve in low density bone (type IV). Various surgical suggestions were advanced in the 1980s which were aimed at achieving optimal osseous integration in poor quality bone. They offered satisfactory short-term results. Recently, as a result of surgical and technological innovations, new therapeutic proposals have shown very interesting results in their initial studies.

At 2 months, the mean BIC% for the dual acid-etched group increased 39.14% compared to the EBC% value, while the mean BIC% for the machined group decreased 44.70%. Based on the histomorphometric results of this study, sufficient bone for functional loading of the implant exists on a dual acid-etched surface after 2 months of healing in the posterior maxillary arch.

The choice of implant diameter depends on the type of edentulousness, the volume of the residual bone, the amount of space available for the prosthetic reconstruction, the emergence profile, and the type of occlusion. Small‐diameter implants are indicated in specific clinical situations, for example, where there is reduced interradicular bone or a thin alveolar crest, and for the replacement of teeth with small cervical diameter. Before using a small‐diameter implant, the biomechanical risk factors must be carefully analyzed. Preliminary reports of this type of implant show good short‐ and medium‐term results. CLINICAL SIGNIFICANCE Specific clinical situations indicate the use of small‐diameter implants: a reduced amount of bone (thin alveolar crest) and where the replacement tooth requires a small cervical diameter. In some cases, the use of small‐diameter implants avoids bone reconstruction.

Historically, the recommended time between placement and functional loading of machined‐surface dental implants has been 3 months for the mandible and 6 months for the maxilla. However, such recommendations are a result of evaluating randomly chosen healing times during the initial phase of implant development and are based on the subsequent clinical outcome of either implant integration or mobility. In recent years, histologic and experimental studies have shown that specifically designed micro‐topographic implant surfaces can result in increased bone‐to‐implant contact at earlier healing times than obtained with machined‐surface implants. Histologic and clinical studies investigating early and immediate implant loading support the premise that implants can be placed into function earlier than previously recommended. With the development of specifically designed implant surfaces and the utilization of time‐saving surgical (one‐stage surgical protocol) and prosthetic (implant position indexing) techniques, patients are now being restored and returning to function sooner than previously thought possible. The purpose of this multicenter clinical investigation is to evaluate the efficacy of loading Osseotite dental implants (3i‐Implant Innovations Inc., Palm Beach Gardens, Florida) at 2 months and to determine the effect of early loading on implant performance and survival. A total of 429 Osseotite implants were placed in 155 patients (87 females and 68 males; mean age 54.0 ± 13.7 yr), at 10 study centers, and subsequently loaded 2.1 ± 0.7 months following placement. A single‐stage surgical protocol was followed, with implants indexed immediately or impressed 4 to 6 weeks following placement. Patient restorative treatments included placement of 83 single‐implant provisional restorations and 129 splinted, two‐, three‐, and four‐implant supported maxillary and mandibular provisional restorations. The mean time from prosthetic loading to the most recent follow‐up evaluation was 10 ± 1.3 months. Seven of the 429 implants did not integrate; of these, six were identified prior to loading and one was identified 1 month after loading. The cumulative implant survival rate was 98.5% at 12.6 months. The cumulative post‐loading implant survival rate was 99.8% at 10.5 months. The preliminary results of this clinical investigation suggest that successful functional loading of the Osseotite dental implant is possible at 2 months following noncomplicated implant placement.

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