Evaluation of Factors Associated with Osseointegration and in Determining Whether Early Loading is Possible

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Evaluation of Factors Associated with Osseointegration and in Determining Whether Early Loading is Possible
Keith Nielsen
Compton Implants
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The scientific foundation of modern dental implantology was first provided when Branemark et al.1 published the first long-term follow-up study on oral implants. According to Branemark and collaborators (Branemark et al.1; Adell et al.2; Albrektsson et al.3; Branemark4), adherence to a strict surgical and prosthodontic protocol was necessary for implant integration predictability. One of these requirements was a stress-free healing period of 3-6 months using a 2-stage surgical procedure. This was to create a healing environment at the bone-implant interface that would facilitate regeneration and osseointegration rather than fibrous tissue encapsulation. The mandibular 3 month, and maxillary 6 month, no-load healing periods were never experimentally determined, as Branemark et al.1 based these periods on ǃ?empirical estimatesǃ?.29 Thus, it is questionable as to whether these healing periods are essential for osseointegration, or, as Henry and Rosenberg5 suggested, just a ǃ?therapeutic reserveǃ?. Such healing periods may be inconvenient for certain patients5,6,7,8, discouraging them from seeking such treatment.9
Many papers have been published stating that a stress-free period is considered to be the ultimate prerequisite for achieving proper osseointegration.32,33,34 Papers comparing immediately loaded implants with submerged implants have also been published showing that immediate loading is not as predictable as allowing a no-load healing period. Dietrich et al.31 compared immediately loaded TPS screws with IMZ cylinders placed according to the 2-stage technique. The authors found that for implant prognosis, healing mode was a statistically significant parameter, and concluded that a
higher failure rate was produced by immediate loading. Conversely, other studies have been done showing that immediately loaded implants have high success rates, similar to the success rates of implants that are loaded after a no-load period.19,35,36 The controversy thus remains as to whether or not early loading is a predictable and viable option.
References:
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2. Adell, R.; Lekholm, U.; Rockler, B.; Branemark, P.-I. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int. J. Oral Surg. 10:387-416; 1981.
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30. Dalton, J. E.; Cook, S. D. In vivo mechanical and histological characteristics of HA-coated implants vary with coating vendor. Journal of Biomedical Materials Research 29:239-245; 1995.
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32. Albrektsson, T.; Zarb, G.; Worthington, P.; Eriksson, R. A. The long-term efficacy of currently used dental implants: A review and proposed vriteria of success. Int J Oral Maxillofac Implants 1:11-25; 1986.
33. Adell, R.; Lekholm, U.; Rockler, B., Branemark, P-I. A 15-year study of osseointegrated implants in the treatment of edentulous jaws. Int J Oral Surg 10:387-416; 1981.
34. Albrektsson, T.; Branemark, P-I; Hansson, H. A.; Lindstrom, J. Osseointegrated titanium implants: Requirements for ensuring a long-lasting, direct bone to implant anchorage in man. Acta Orthop Scand 52:155-170; 1981.
35. Salama, H.; Rose, L. F.; Salama, M.; Betts, N. J. Immediate loading of bilaterally splinted titanium root form implants in fixed prosthodontics: A technique re-examined. Two case reports. International Journal of Periodontology and Restorative Dentistry 15:345-361; 1995.
36. Spiekermann, H.; Jansen, V. K.; Richter, E-J. A 10-year follow-up study of IMZ and TPS implants in the edentulous mandible using bar-retained overdentures. International Journal of Oral and Maxillofacial Implants 10:231-243; 1995.
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