Immediate Loading of Single-Tooth Restorations: One-Year Prospective Results

Abstract

Immediate loading of splinted implant restorations is a growing trend, but limited clinical documentation hampers evidence-based treatment planning for single-tooth applications. This study prospectively evaluated the clinical efficacy of placing implant-supported, single-tooth restorations into immediate, full-occlusal loading. Sixty consecutive patients (intent-to-treat group) with 1 missing tooth between 2 intact teeth were treated with a total of 69 implants. At placement, final impressions were made and implants were provisionalized with nonoccluding prostheses. Definitive prostheses were delivered 2 weeks later. A claim of noninferiority was made with a 95% confidence interval (Mann-Whitney U test) if the success rates between the experimental group and a 97% historical control was > 7%. Standardized radiographs taken at placement and bimonthly intervals were analyzed for crestal bone changes at a type I (alpha) error level of .05; significance levels were not adjusted for multiplicity (Fisher exact tests and Student t tests). Sixteen patients (18 implants) were withdrawn for protocol deviations. The resulting treated-per-protocol group consisted of 44 subjects with 51 implants. Cumulative implant success rates were 98.55% (n = 68/69) for the intent-to-treat group and 98.04% (n = 50/51) for the treated-per-protocol group. There were no significant adverse events or statistically significant differences between the experimental and historical control groups. At 12 months mean crestal bone loss was 1.05 mm, and ranged from 0.38 to 1.5 mm (77%) and 1.6 to 2.69 mm (23%). Immediate full-occlusal loading of single-tooth restorations was safely performed in selected subjects when good primary implant stability and an appropriate occlusal load were achieved.

Immediate Loading of Trabecular Metal‐Enhanced Titanium Dental Implants: Interim Results from an International Proof‐of‐Principle Study

“…Mean implant bone loss rates were 0.43 ± 0.41 mm for PTTM implants ( n = 36) in the present PoP study and 0.98 ± 0.67 mm for the fully threaded implants ( n = 50) in the historical control study . Based on these data, a p value of <.001 was obtained by the Satterthwaite t ‐test.…”

“…In the focus group, implant survival was 100% ( n = 22/22) and mean crestal bone loss from immediate provisionalization to the 1‐year follow‐up was 0.43 ± 0.41 mm (Table ). In comparison, the historical control study that used the same protocol with fully threaded implants reported 98.04% ( n = 50/51) implant survival and 1.05 mm (range = 0.38–2.69 mm) ( n = 50) of mean cumulative bone loss.…”

“…Based on these data, a p value of <.001 was obtained by the Satterthwaite t ‐test. Thus, the null hypothesis was rejected at a .05 significance level, and it was claimed that the mean marginal bone loss amount of PTTM implants was significantly less than the mean marginal bone loss amount of the historical control implants. A 95% two‐sided confidence interval for the difference in mean marginal bone loss amounts between fully threaded implants in the historical control study and PTTM implants in the present PoP study were estimated as (0.3176, 0.7824).…”

“…In comparative animal studies, researchers have reported that immediately loaded dental implants developed significantly denser peri‐implant bone than implants subjected to delayed loading. A limitation in the present human study was that use of the historical control precluded any direct radiographic comparisons with implants subjected to delayed loading. Thus, the question of how bone ingrowth into the porous PTTM material may affect the density of the peri‐implant bone could not be answered by the present data.…”

“…The study implants differed from the historical control implants by a lack of threads in the midsection of the implant where the PTTM material was placed and the addition of circumferential microgrooves and microtexturing in the cervical region of the implant that extended to within 0.5 mm of the coronal platform. In comparison, implants in the historical control study were fully threaded with traditional machined (turned) surfaces and no microgrooves in their cervical regions. The clinical efficacy of milled cervical microgrooves and microthreads on marginal bone preservation has been debated in the literature .…”