Immediate function on the day of surgery compared with a delayed implant loading process in the mandible: a randomized clinical trial over 5 years

Abstract

ObjectivesTo appraise the feasibility of loading four implants with a pre-existing denture converted to a fixed dental prosthesis (FDP) on the day of implant surgery compared with waiting for 3- to 4-month healing.MethodsPatients with an edentulous, fully healed mandible were recruited in a faculty clinic to partake in a blinded two-arm parallel randomized controlled trial (RCT). The participants received four parallel intraforamina mandibular implants with a moderately rough titanium surface (Brånemark System Mk III or Mk IV TiUnite; Nobel Biocare AB, Göteborg, Sweden). The implants were loaded on the same day by converting the participants' pre-existing denture in the experimental group. The implants were placed using a one-stage surgery procedure, and the participants' pre-existing denture were soft-relined in the control group. For both groups, the permanent 10- to 12-unit FDP consisting of a type-3 cast precious alloy veneered with acrylic and artificial teeth was placed 3–4 months after implant surgery. All participants have been recalled annually for 5 years for appraisal of bone loss and registration of adverse events.ResultsThirty-five of the original 42 participants (83%) returned for clinical and radiological examinations at the 5-year follow-up recall. No selective dropout or specific reasons for dropout was identified in the two study arms; leaving n = 17 (Intention-to-treat group, ITT) in the experimental group, alternatively n = 13 as per protocol group (PP), and n = 18 participants in the control group (ITT = PP). At study commencement, five of the participants assigned to the experimental group did not receive their planned intervention. In the control group, one implant failed to osseointegrate and another failed due to bone loss after 5 years. The crestal bone level changes over 5 years were identical in the experimental and control groups, that is, 1.2 mm (SD = 0.7). There were no differences between the two study arms with regard to incidence of biological and technical adverse events.ConclusionsImplants in the anterior mandible loaded immediately with a converted pre-existing denture appear to yield analogous clinical outcomes compared with waiting for 3–4 months over the first 5 years following implant surgery.

Comparison of clinical and radiographic status around immediately loaded versus conventional loaded implants placed in patients with type 2 diabetes: 12‐ and 24‐month follow‐up results

“…The authors concluded that immediately and delayed‐loaded implants in healthy individuals had the same prognosis after 24 months . A number of randomised controlled trials (RCTs) on healthy subjects have assessed implant failure rates under immediate loading compared with delayed loading . These studies have reported no statistically significant difference in implant failure rate between IL versus DL implants (2·87% versus 1·8%, respectively) .…”

A Systematic Review of Clinical Outcomes on Patients Rehabilitated with Complete‐Arch Fixed Implant‐Supported Prostheses According to the Time of Loading

“…Twelve studies compared immediate and conventional loading protocols. From these, four studies were RCTs, five were prospective studies, and three were retrospective studies . Four studies compared early loading and with conventional loading, from which two were RCTs and two were retrospective studies .…”

“…The most common technical complications were: resin or tooth fracture and loosening of the abutment screw. Four studies provided information concerning biological complications . These studies showed that immediate and early loading protocols had a higher number of patients with soft tissue ulcers, hyperplasia/inflammations, and peri‐implantitis.…”

“…It is still unknown whether dental implants should be immediately loaded or if it is a conventional loading protocol should be followed for more consistent outcomes . The immediate restoration/loading protocol has many advantages such as quicker achievement of occlusal function, early restoration of esthetic appearance, avoidance of a second surgery to expose the implant, and an increase in the percentage of transverse collagen fibers . Furthermore, with an immediate restoration/loading protocol, it is possible to avoid the use of a removable denture, which could cause functional and esthetic disturbances …”

Early loading of splinted implants in posterior mandible: Three‐year results of a prospective multicenter study

“…Pre‐mature loading may be easier to lead to fibrous tissue encapsulation around implants instead of direct osseointegration (Branemark, ; Branemark et al, , , ). Although the protocols of immediate loading or early loading for implants can provide ideal survival rates and clinical outcomes in certain specific situations in some studies (Blanco et al, ; Fuh et al, ; Galindo‐Moreno et al, ; Haverstock et al, ; Jokstad & Alkumru, ), using an early loading protocol for an indication where it is not a viable treatment option may cause implant failure. Faced with different clinical realities, relevant factors should be considered when choosing an early loading protocol, for example maintenance of implant stability and controlled loading (Glauser, Lundgren, et al, ), achievement of primary stability (Eliyas & Al‐Khayatt, ; Esposito, Grusovin, Willings, Coulthard, & Worthington, ; Glauser, Rée, et al, ), selection of implant system (Albrektsson, Branemark, Hansson, & Lindstrom, ; Geckili, Bilhan, & Bilgin, ; Simunek et al, , ), types of restoration, bone quality (Simunek et al, , ) and implant sites (Glauser, Rée, et al, ).…”