Clinical Evaluation of Immediate Loaded Upper Anterior Single Implants

Clinical Evaluation of Immediate Loaded Upper Anterior Single Implants
March 2005
By: Tsirlis, Anastasios T. DDS - Associate Professor, Department of Alveoral Surgery, Surgical Implantology, and Roentgenology, Dental School, Aristotle's University of Thessaloniki, Greece
LLWOnline / The International Journal of Oral Implantology
Abstract TOP
Among the guidelines to be followed in the selection of patients who are suitable for treatment with dental implants, there must be accurate assessment and evaluation of the factors that will lead to a functionally long-lasting and aesthetically pleasing result. The latter, which includes the maintenance and development of hard and soft tissues, undoubtedly presents a significant challenge in clinical implantology. The purpose of this study was the clinical evaluation of the methods currently available for the aesthetic restoration of the anterior maxilla using single implants that were loaded immediately. Forty-three patients were treated over 2 years using single implants with immediate nonfunctional loading. The patients were divided into two groups, groups A and B (i.e., immediate implant installation and late implant installation, respectively). Guided bone regeneration techniques were performed in 10 patients in group A and three patients in group B and involved buccal fenestrations orbuccal dehiscence around the implants. The parameters studied were: 1) the anatomical requirements necessary in selecting such patients and the limitations that might affect (to a lesser or greater degree) the desired results; 2) the planning and application of surgical techniques, both with immediate and short-term delay postextraction implantation, as well as the placing of implants in areas with long-term dental loss; and c) the results, after radiologic and clinical follow-up visits every 6 months, for an overall period of 2 years. No implant failure was recorded, and the therapeutic procedures were considered completely successful in all cases, without significant radiographic peri-implant marginal bone loss (i.e., average bone loss in mm 迂 SD, 0.75 迂 1.05 in group A and 0.875 迂 0.625 in group B) or significant clinical differences in peri-implant sulcus depth (average difference in mm 迂 SD, 0.3 迂 0.2 in group A and 0.4 迂 0.375 in group B). In cases where guided bone regeneration techniques were applied, the results were considered successful and final, and the aesthetic results were deemed more satisfactory than was expected. The procedure was successful in all cases in terms of both osseointegration and aesthetics. The use of dental implants with nonfunctional loading in particularly sensitive aesthetic areas is recommended unreservedly, given the existence of the anatomical requirements, good initial stability, and the absence of extensive bone loss in the area receiving the implant. In addition, application of this treatment method leads, within a very short time, to a particularly successful aesthetic result, reducing the number of surgeries and the duration of treatment.
Results
A common characteristic observed in all cases was the absence of complications and the initial healing of the soft tissue around the temporary restoration within the first 10 days (Figs. 11 and 12). The results of linear radiographic bone loss as well as the peri-implant sulcus depth in the total 24-month period are presented in Table 2. No implant failure was recorded, and the therapeutic procedures were considered completely successful in all cases, without significant radiographic peri-implant marginal bone loss (average bone loss in mm 迂 SD, 0.75 迂 1.05 in group A and 0.875 迂 0.625 in group B) or significant clinical differences in peri-implant sulcus depth (average difference in mm 迂 SD, 0.3 迂 0.2 in group A and 0.4 迂 0.375 in group B). The implants were completely stable. As far as the implant/maxilla interface and the aesthetics of the final peri-implant restorations were concerned, the results proved completely satisfactory (Figs. 13, 14, and 15). Even in the cases where GBR techniques were applied, the results were considered successful and final, whereas the aesthetic results were deemed more satisfactory than was expected.
Discussion
From a clinical point of view, of critical importance in the prognosis is good initial stability of the implant rather than the immediate nonfunctional loading. Micromovements of more than 100 巡 are sufficient to jeopardize healing with direct bone-to-implant contact.41,42 This observation was also reported by Szmukler-Moncler et al,43 who indicated that micromotions at the bone/implant interface beyond 150 巡 resulted in fibrous encapsulation instead of osseointegration. It can be further speculated that these movements would be detrimental in cases with immediate implant loading. An adequate initial stability of the implant was the main concern of the present study.
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