A 7-YEAR FOLLOW-UP OF 93 IMMEDIATELY LOADED TITANIUM DENTAL IMPLANTS

A 7-YEAR FOLLOW-UP OF 93 IMMEDIATELY LOADED TITANIUM DENTAL IMPLANTS
2005)
Marco Degidi, MD, DDS
Adriano Piattelli, MD, DDS
American Academy of Implant Dentistry Journal 31:25ÇƒÏ31
KEY WORDS
Bone reactions
Follow-up study
Immediate loading
Prospective study
Titanium implants
Recently, several experimental and clinical investigations found that immediately loaded implants obtained satisfactory levels of osseointegration with high success percentages. Only a few long-term studies of immediately loaded implants have been reported in the literature. The aim of this study was a 7-year clinical and radiographic follow-up of 93 immediately loaded dental implants in human patients. Eleven patients were consecutively enrolled in this study. A total of 7 full and 9 partial edentulous arches were rehabilitated. Patients presented a completely edentulous mandible (n = 6), a completely edentulous maxilla (n = 1), mandibular posterior edentulous areas (n = 5), or a posterior maxillary edentulous area (n = 1). Patients were rehabilitated with a bar and an overdenture (n = 4), a provisional prosthesis of 3 to 12 elements (n = 11), or a metal-ceramic bridge of 10 elements (n = 1). A total of 93 implants were inserted and loaded within a 24-hour time frame. Six implants failed in the first year after loading. No more failures were observed in the following 6 years, and all the other implants were well integrated from a clinical and radiographic point of view. The cumulative success rate at 7 years was 93.5%, and the prostheses survival rate was 98.5%. The mean marginal bone loss was 0.6 mm after the first year and 1.1 mm at the 7-year evaluation. Primary stability is one of the most important parameters in immediately loaded implants because it avoids micromotion at the bone-implant interface. Four of the 6 failures in our patients occurred in partially edentulous patients; an excessive load applied to these small bridges could be the reason for the failure. Also, the bone quality is important, for 3 of our failed implants had been inserted in D3 bone. Our clinical and radiographic results have shown that these immediately loaded implants have remained osseointegrated for a long period. Our results point to the possibility of using the immediate loading technique in selected and well-informed cases.
INTRODUCTION
A submerged healing period of about 3 to 4 months was deemed necessary for the formation of mineralized bone around dental implants, whereas a too-early loading with excessive interfacial micromotion could affect the peri-implant tissues in an untoward manner with the occurrence of a fibrous tissue at the bone-biomaterial interface.1,2 Little is known, however, on the strain distribution in bone around dental implants after loading with its triggering effects on cells and their biological activities.2 Excessive micromotion probably damages the early scaffolding from the fibrin clot, impeding its adherence to the implant surface.2 Furthermore, the initial necrotic bone at the interface between bone and implant was believed to be unable to bear the prosthetic load until it was replaced by newly formed bone.3,4 This waiting period may cause functional and psychological problems to the patients,5 with the discomfort of wearing complete dentures, and could be one of the reasons why some patients do not choose implant-supported restorations.6 The immediate loading technique, on the other hand, reduces the morbidity associated with fewer surgical interventions and facilitates the functional rehabilitation.7 Moreover, because soft and hard tissues heal concurrently, the length of treatment can be reduced.8 Recently, several investigators found that immediately loaded implants placed in different clinical conditions were able to obtain clinically satisfactory levels of osseointegration with high success percentages.7,9ÇƒÏ20 The term immediate loading should be reserved only for the implants that are loaded in the time frame of 24 hours. Only a few long-term studies of immediately loaded implants have been reported in the literature. The aim of this study was a 7-year clinical follow-up of 93 immediately loaded dental titanium implants in human patients.
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