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The findings of this prospective study indicate that both suggested protocols for tooth extraction in patients treated with oral BPs can provide a predictable treatment outcome (100 % success). Therefore, because atraumatic surgery is more comfortable for patients, we suggest the adoption of Protocol B, which limits trauma to both the soft and hard tissues.

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Background: To date, only few studies have reported on the clinical outcomes of immediate postextraction implant placement and immediate loading. Purpose:The purpose of this retrospective study was to report the results of immediately loading of four implants placed in fresh extraction sockets in the mandible after a follow-up of 24 months. Materials and Methods:Between January 2001 and January 2009, 50 patients (28 women and 22 men, average age 54 years) had 347 teeth extracted and a total of 200 dental implants placed in the mandible. The patients received a provisional fixed bridge the same day and a permanent one 3 months later. Clinical check-ups were performed after 1, 2, 3, 6, 12 and 24 months. Marginal bone measurements were made in intraoral radiographs taken one day after surgery and after one year. A questionnaire was used to evaluate self-perceived factors related to comfort, aesthetics and function.Results: All bridges were stable and no implant failures were recorded during the follow-up, giving a survival rate of 100%, at two years. The marginal bone loss amounted to 1.33 + 0.36 mm after one year and 1.48+ 0.39 mm after two years. Ten patients showed prosthetic complications with the provisional bridge, but all the definitive prostheses remained stable throughout the study period without any complications. The patients reported satisfaction with the treatment. Conclusions:The present retrospective study showed that immediate loading of four implants immediately placed in extraction sockets is a valid treatment modality for the totally edentulous mandible. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Page 2 of 27 Clinical Implant Dentistry and Related Research INTRODUCTIONDue to a better understanding of biological and biomechanical features together with the notable progress in dental implant morphology and surface characteristics, immediate loading has become an attractive alternative to conventionally loaded implants 1 . Despite the fact that numerous studies on immediate, or early loading have been published 1,2,3, over the last few years 4,5,6,7 , scientific literature contains several different definitions and evaluation criteria as to the immediate loading concept. Indeed, authors refer to immediate loading even when dealing with a 20 8 or even 30-day period 9 between surgery and actual loading. In the fourth ITI Consensus Conference, immediate loading was defined as a prosthesis that is placed in occlusion with the opposing dentition within 48 hours of implant placement 10 .The concept of immediate loading was first applied to the loading of multiple implants in both the maxilla and mandible 11 for full arch restorations 11,12,13,14 , with predictable results.Currently, the survival rates for implants subjected to immediate loading in mature mandible bone vary between 80% and 100% 15,16,17,18,19 . Howeve...

There is disagreement as to whether it is safe to place implants in patients under bisphosphonates (BPs) therapy owing to the risk for developing BP-related osteonecrosis of the jaws (BRONJ). The American Association of Oral and Maxillofacial Surgeons recommends that dental implants should be avoided in oncologic patients treated with intravenous BPs. Conversely, for patients receiving oral BPs, dental implant placement is not explicitly contraindicated even if a cautious approach is suggested. The aim of the current study was to assess the risk level as related to adverse events such as implant failure and BRONJ in a large cohort of osteoporotic patients submitted to implant placement and concomitant application of plasma rich in growth factor (PGRF)-Endoret. The clinical charts of 235 middle-aged women under oral BPs therapy for osteoporosis, who underwent positioning of 1267 dental implants, were reviewed. The implants were always positioned in association with PRGF-Endoret. The outcomes were implant failure and BRONJ. A model based on personal risk factors distribution was used for risk assessment. Sixteen implants were lost in 16 patients up to 120 months of follow-up, leading to a survival of 98.7% and 93.2% on an implant basis and patient basis, respectively. No cases of BRONJ were reported. In line with the current literature, the present data show that the risk for developing BRONJ associated to dental implant surgery remains low for patients receiving oral BPs. The use of procedures that could enhance and support healing, such as platelet concentrates, should be recommended.

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