Immediate Occlusal Loading of Dental Implants: Factors Important to Success

Immediate Occlusal Loading of Dental Implants: Factors Important to Success
Maria-Astrid Urrutia, DDSIII
Compton Implants
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Dental implants have been around for over 30 years and have revolutionized the dental profession. The current trend is moving towards the immediate loading of fixed implant retained prostheses. Immediate loading of dental implants offers many advantages to the patient as well as the dentist. It allows for a single stage surgery, thereby avoiding the physical trauma and chair time of the uncovering procedure, and esthetics and function can be immediately restored (Siddiqui et al, 2001; Degidi et al., 2002). Immediate loading shortens the total rehabilitation time, with increasing patient satisfaction, and it avoids the delays in the final rehabilitation and the difficulty of wearing a conventional denture during the healing phase (Degidi et al., 2002)
The goal in implant placement is the complete osseointegration of the implant to bone. Osseointegration can be defined as the ǃ?direct functional and structural connection between living bone and the surface of a load-bearing implantǃ? (Albrektsson et al., 1981). The original two-stage protocol for dental implant treatment proposed a healing period between implant placement and the loading of the implant. Conventionally, implants are placed and allowed to heal and integrate for 3 months in the mandible and 6 months in the maxilla, before a second stage procedure, in which abutment placement and loading takes place. It was believed that this healing period was essential in order for osseointegration to take place. Micromovements of the implants, if immediately loaded, were believed to disturb the early phase of bone healing and remodeling, resulting in connective tissue proliferation and fibrous encapsulation of the implant, with little or no osseointegration (Branemark et al, 1983). This classic two-stage protocol proposed by the Branemark system has recently been challenged. . Many studies have demonstrated that the immediate loading of implants can in fact be successful. Failures of immediately loaded implants can be avoided by careful attention to certain key requirements. The following clinical conditions and requirements were proposed by Hahn (2000): 1) good quality (types I and II) bone; 2) the ability to place an implant that is 12 to 16mm long; 3) adequate keratinized soft tissue; and 4) the ability to protect the healing implant(s) from excessive occlusal forces (Hahn, 2000). Romanos et al., proposed other factors also important to the success of immediately loaded implants, 1) surface pattern of the implant material (microinterlocking properties); 2) design of the implant (macrointerlocking properties); and 3) adequate splinting, i.e., immobilization of the implants immediately after surgery.
REFERENCES
Albrektsson T, Branemark PI, Hansson H, Lundstom J. Osseointegrated titanium implants: requirements for insuring a long-lasting, direct bone-to-implant anchorage in man. Acta Orthop Scand. 1881; 52: 155-17.
Anderson E, Haanaes HR, Knutsen BM. Immediate loading of single-tooth ITI implants in the anterior maxilla: a prospective 5-year pilot study. Clinical Oral Implants Research. 2002; 13(3): 281-7.
Branemark PI. Osseointegration and its experimental background. Journal of prosthetic dentistry. 1983; 50; 399-410.
Chaushu G, Chaushu S, Tzorhar A, Dayan D. Immediate loading of single-tooth implants: immediate versus non-immediate implantation. A clinical report. International Journal of Oral and Maxillofacial Implants. 2001; 16(2):267-72.
Chow J, Hui E, Liu J, Li D, Wat P, Li W, Yau YK, Law H. The Hong Kong Bridge Protocol. Immediate loading of mandibular Branemark fixtures using a fixed provisional prosthesis: preliminary results. Clinical Implant Dentistry and Related Research. 2001; 3(3):166-74.
Degidi M, Petrone G, Iezzi G, Piatelli A. Histologic evaluation of a human immediately loaded titanium implant with a porous anodized surface. Clinical Implant Dentistry and Related Research. 2002; 4(2):110-4.
Glauser R, Ree A, Lundgren A, Gottlow J, Hammerle CH, Scharer P. Immediate occlusal loading of Branemark implants applied to various jawbone regions: a prospective, 1 year study. Clinical Implant Dentistry and Related Research. 2001; 3(4): 204-13.
Single-stage, immediate loading, and flapless surgery. Journal of Oral Implantology. 2000:26(3): 193-8.
Henry PJ, Tan AES, Allan BP, Hall J, Johanssen C. Removal torque comparison of TiUnite and turned implants in the greyhound dog. Applied Osseointegration Research. 2000; 1:15-17.
Lozada J. Eight year clinical evaluation of HA-coated implants. J Dent Symp. 1993; 1:67-69.
Malo P, Rangert B, Dvarsater BA. Immediate function of Branemark implants in the esthetic zone: a retrospective clinical study with 6 months to 4 years of follow-up. Clinical Implant Dentistry and Related Research. 2000; 2(3): 138-146.
Romanos G, Toh CG, Siar CH, Swaminathan D, Ong AH, Donath K, Yaacob H, Nentwig GH. Peri-implant bone reactions to immediately loaded implants. An experimental study in monkeys. Journal of Periodontology. 2001; 72(4): 506-11.
Siddiqui AA, Ismail JY, Kukunas S. Immediate loading of dental implants in the edentulous mandible: a preliminary case report from an international prospective multicenter study. Compendium of Continuing Education in Dentistry. 2001; 22(10): 867-70, 873-4, 876.
Szmukler-Moncler S, Salama H, Reingewirtz Y, Dubrille JH. Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature. Journal of Biomedical Materials Research. 1998; 43(2): 192-203
Testori T, Szmukler-Moncler S, Fracetti L, Del Fabbro M, Scarano A, Piatelli A, Weinstein RL. Immediate loading of Osseotite implants: a case report and histologic analysis after 4 months of occlusal loading. International Journal of Periodontics and Restorative Dentistry. 2001; 21(5): 451-9.