Wound healing in immediately loaded implants

Abstract

The orthopedic field has accumulated ample evidence that bone formation is related to functional loading and in general to physical activity. However, despite evidence that immediately loaded implants can be predictably successful, many clinicians still use the classical (delayed loading) treatment protocol. This paper examines the effects of loading on dental implants and discusses the advantages of immediate loading. The role of loading on augmented alveolar ridges is also addressed and provides evidence that early bone resorption may be controlled when bone is functionally loaded. Similar data are emerging for advanced augmentation techniques in order to control crestal bone loss.

Healing differences in narrow diameter implants submitted to immediate and conventional loading in mandibular overdentures: A randomized clinical trial

“…Thus, the unfavorable secondary stability of the IML group could be partially attributed to the inability of atrophic bone to respond rapidly to mechanical loads. These results may also justify the biological responses in the IML group, as bone atrophy is associated with immobilization of the long‐term receptor bone bed, which may in turn affect the vascular support of the bone . These characteristics could delay the formation of a connective tissue rich in vascular units and fibroblasts in direct contact with the surface of the implant, which normally forms during the second week of bone healing .…”

“…However, studies have also shown that mechanical stimuli motivate pre‐osteoblasts to develop bone matrix proteins (osteocalcin) . This eventually results in a significantly higher bone density between the threads of the implant in the IML group (11.6% higher than the CL group) …”

“…These results may also justify the biological responses in the IML group, as bone atrophy is associated with immobilization of the long-term receptor bone bed, which may in turn affect the vascular support of the bone. 32 These characteristics could delay the formation of a connective tissue rich in vascular units and fibroblasts in direct contact with the surface of the implant, which normally forms during the second week of bone healing. 33 Bielemann et al 12 followed the healing of two NDIs as F I G U R E 3 Box-plots show the medians levels of the inflammatory marker concentrations (pg/μL): intra-group and intergroup comparisons at different periods for IML and CL.…”

Immediate occlusal vs nonocclusal loading of implants: A randomized prospective clinical pilot study and patient centered outcome after 36 months

“…Yet our finding of no difference in survival/success rates is in contrast to a previous study of 307 implants supporting two-to four-unit fixed partial dentures in 117 patients. 18 Even so, histological studies suggested clinically stable implants also in heavy smokers after immediate functional loading of implants. Seven implants, most of them in two-unit restorations, accounted for this difference.…”

“…9 Immediate loading yielded a 12-month success rate of 97.5% based on 40 implants supporting splinted restorations in 20 patients with missing mandibular premolars and molars. 17 Nonfunctional protocols of immediate loading have been introduced so as to protect newly inserted implants from exposure to any excessive functional or parafunctional forces in partially edentulous patients, 18 as complications like bruxism and severe clenching have been suspected to increase the risk of failure among immediately loaded implants. 17 Nonfunctional protocols of immediate loading have been introduced so as to protect newly inserted implants from exposure to any excessive functional or parafunctional forces in partially edentulous patients, 18 as complications like bruxism and severe clenching have been suspected to increase the risk of failure among immediately loaded implants.…”