Immediate functional loading of TiOblast dental implants in full‐arch edentulous mandibles: a 3‐year prospective study

Abstract

Introduction: Implant‐prosthetic rehabilitation of the completely edentulous mandible has evolved to a simplified procedure with shorter treatment time and survival rates of 95–100% depending on the implant system used. Purpose: The aim was to evaluate the 3‐year clinical success of Astra Tech TiOblast implants, functionally loaded on the day of surgery with a fixed full‐arch bridge in the mandible. Materials and methods: One hundred and twenty‐five implants of 3.5–4 mm width and 11–17 mm length were installed in 25 edentulous mandibles of 15 female and 10 male patients. Implants were functionally loaded on the day of surgery with a provisional, acrylic, glassfibre reinforced, 10 unit bridge. After 3–4 months, the final 12‐unit bridge was constructed. Radiographical bone loss was measured on peri‐apical radiographs after 3, 12, 24 and 36 months. Results: All implants were functional during the whole study period yielding a survival rate of 100%. None of the fixtures showed pain or mobility after manual torque with 20 N cm at the 3‐month control. Mean radiographical bone loss after 3 months and 1, 2 and 3 years was 0.6 mm (SD 0.7), 0.8 mm (SD 0.8), 1 mm (SD 0.8) and 1.3 (SD 1) respectively, which was statistically significantly increasing up to 1 year. Conclusion: Immediate loading of full‐arch mandibular bridgework on five TiOblast implants offers a long‐lasting clinical result with 100% fixture survival and stable bone‐to‐implant contact up to 3 years.

Immediate Rehabilitation of Completely Edentulous Jaws With Fixed Prostheses Supported by Implants Placed Into Fresh Extraction Sockets and in Healed Sites

“…Taking into account these preliminary considerations, the positive results described in this present study can be attributed to the interaction of several favorable contributing factors: the use of implants with the longest possible lengths, an immediate crossarch splinting of the implants with a passively fitting bar minimizing micromobility, and an even occlusal load distribution on a sufficient number of implants. In our study, each patient received 6 to 8 implants: in the upper jaw, the implants were distributed at sites 3,5,6,8,9,11,12, and 14, whereas in the mandible, they were distributed at sites 19, 21, 23, 26, 28, and 30. Whenever possible, depending on the opposing dentition, the cross-arch implant-supported restoration was given a fully balanced occlusion and articulation with an equal spread of the load to all implants.…”

“…7 It has been seen that immediate loading reduces functional discomfort and also improves the outcome of the implants, thus avoiding the risk of implant failure due to the unexpected overload imposed on the top of the fixtures in the early healing phase. 8 Survival rates of 96% to 100% are reported for immediately loaded full-arch fixed prosthesis in the mandible. [9][10][11] Few studies have evaluated the success of immediately loaded implants in the edentulous maxilla, but the preliminary results seem encouraging.…”

A Randomized Controlled Clinical Trial of Edentulous Patients Treated with Immediately Loaded Implant‐Supported Mandibular Fixed Prostheses

“…16,21,22 The more recent short-and medium-term studies have reported invariably higher success rates (90-100%) for immediately loaded implants when combined with fixed prostheses. [23][24][25] These high success rates were attributed to several factors, such as ensuring balanced occlusion and equal distribution of forces between the loaded implants especially when incorporating cantilevers in the prosthesis designs. 17,23,[26][27][28][29] Moreover, in order to reduce surgical morbidity as well as costs of implants (associated both with treatment and posttreatment), there has been increasing interest in the reduction of the number of implants for the support of prostheses.…”

“…Indeed, this too has now become an important area of study with several studies focused on the determination of how many fixtures are necessary to provide successful support of their overlying prostheses. 17,21,24,26,30,31 As mentioned above, a number of clinical studies have attempted to investigate the efficacy of the immediate loading concept as a feasible treatment modality. However, most studies had no control groups, to which outcomes of the immediate loading treatment could be compared, thus limiting the validity of the conclusions reached.…”

Osseointegration: Hierarchical designing encompassing the macrometer, micrometer, and nanometer length scales

“…This phenomenon has been the basis for multiple orthopedic and dental rehabilitation procedures, paving the way for quality of life improvement of a large number of patients [6]. The introduction of titanium and its alloys to implant dentistry has marked an era where the main driving force for advances in implant engineering has been centered at decreasing or eliminating the hiatus between surgical placement and functional loading due to improved host-to-implant response [7][8][9][10]. Nonetheless, clinical and basic research on the field of implant dentistry resulted in a lack of sequential and hierarchical approach for implant designing that challenges biomedical engineers to retrospectively address the interaction of the main design parameters such as macrogeometry, microgeometry, nanogeometry, and surgical instrumentation in an objective fashion [11].…”