Considerations preliminary to the application of early and immediate loading protocols in dental implantology

Abstract

In oral implantology, a 3-6 month stress-free healing period is presently accepted as a prerequisite to achieve bone apposition without interposition of a fibrous scar tissue. This protocol was introduced by Brånemark and co-workers in 1977. The aim of the present paper is to review the reasons that led Brånemark and collaborators to require long delayed loading periods. It is shown that the requirement for long delayed loading periods was drawn from the initiation and development periods of their original clinical trial. Demanding conditions were met involving simultaneously: 1) patients with poor bone quality and quantity, 2) non-optimized implant design, 3) short implants, 4) non-optimized surgical placement, 5) non-optimized surgical protocol and 6) biomechanically non-optimized prosthesis. Extrapolation of the requirement for long healing periods from these particular conditions to more standard situations involving refined surgical protocols and careful patient selection might be questioned. Albeit premature loading has been interpreted as inducing fibrous tissue interposition, immediate loading per se is not responsible for fibrous encapsulation. It is the excess of micromotion during the healing phase that interferes with bone repair. A threshold of tolerated micromotion exists, that is somewhere between 50 microns and 150 microns. It is suggested that loading protocols might be shortened through 2 different approaches. The first way would be to decrease stepwise the delayed loading period for free-standing implants below the presently accepted 3-6 months of healing. The second way would be to identify immediate loading protocols that are capable of keeping the amount of micromotion beneath the threshold of deleterious micromotion. Immediate loading protocols for implants-retained overdentures and fixed bridges are reviewed. It is shown that successful premature loading protocols require a careful and strict patient selection aimed to achieve the best primary stability. These various protocols need to be further documented in order to assess their predictability.

Transitioning patients from teeth to implants

“…Practitioners should be aware that the Branemark protocol was empirical and based on clinical observation; it was a protocol that insured integration of implants but each and every step may not be necessary. 18 Treatment of fully edentulous patients with dental implants highlighted many complications during the osseointegration phase. Complications involving complete dentures worn during the period of osseointegration included loose dentures, fractured prosthesis, sore spots and periodic provisional relines.…”

Análisis Descriptivo de la Reparación Ósea Asociada a Implantes Dentales Endóseos Instalados en Perros con Técnica Sumergida en Dos Períodos de Evaluación

“…Desde sus comienzos, la implantología oral ha sido objetivo de amplias investigaciones que han permitido un empleo cada vez más difundido gracias a la seguridad de las técnicas de instalación junto a los elevados índices de éxito y sobrevida (Szmukler-Moncler et al, 2000; Belser et al, 2004). Es difícil pensar en la odontología moderna sin las técnicas de implantología oral a nuestra disposición.…”

Immediately loaded full-arch provisional implant restorations using CAD/CAM and guided placement: maxillary and mandibular case reports

“…With full arch immediate load prostheses this can be achieved when implants attain adequate primary stability at the time of placement, are subject to rigid inter implant splinting, and occlusal forces are appropriately controlled during the osseointegration period. [3][4][5][6][7] Taking surgical protocols and patient management a step further, there has also been a growing interest in explor ing the potential of a fl apless surgical approach to minimise post-operative trauma and accelerate postoperative healing. [8][9][10] However, this approach can risk significant complications should the operator misinterpret the underlying hard and soft tissue anatomy.…”