Immediate Vs. Early Loading of Bone Level Tapered Dental Implants with Hydrophilic Surface in Fully Edentulous Maxilla:Clinical and Patient-Centered Outcomes

ABSTRACT The aim was to: (i) compare changes among primary and secondary implant stability between immediate and early loaded implants in edentulous maxilla, (ii) evaluate oral health related quality of life (OHRQoL) and (iii) determine patient satisfaction with 6-implant supported fixed full-arch dentures. A prospective, randomized controlled clinical trial was conducted on 24 edentulous maxilla patients. The BLT SLActive® implants in 12 patients were immediately loaded with temporary restorations while12 patients did not receive temporary restorations. Definitive (final) dentures were delivered to all patients after 6 weeks. Stability of the implants were assessed by Insertion Torque (IT) and Resonance Frequency Analysis (RFA). Oral Health Impact Profile-19 ( OHIP-19) questionnaire was used to evaluate OHRQoL and a Visual Analogue Scale (VAS) for patient satisfaction. The IT value of implants assigned for immediate and early loading group was 27.17±9.55Ncm and 25.01±11.06Ncm, respectively. Changes in implant stability from baseline to week 6 were similar in both groups when measured by Penguin ® (p=0.881) and Ostell ® (p= 0.828). Patients in the immediate load group reported significantly lower OHIP physical pain scores (p=0.016), OHIP psychological disability score (p=0.046) and significantly higher VAS function score (p=0.009) and VAS aesthetics score (p=0.009). Implant loading protocols don’t have a significant effect on the change in implant stability 6 weeks after implantation, however, immediate loading significantly improves OHRQoL and satisfaction of patients with maxillary edentulism treated by fixed full-arch dentures. Future trials will determine the role of immediate loading protocol in clinical scenarios with various amounts of available jaw bone using different numbers of implants to retain a fixed prosthetic restoration in the edentulous maxilla.

Immediate load implants: systematic review of the major technical and patient comfort approaches

Introduction: The first implant follow-up studies constituted the scientific foundation of modern implantology. Early loading was identified as a critical factor and, therefore, several waiting times were tried until the establishment of a period of at least three months for the mandible and five to six months for the maxilla. Therefore, implant with immediate load (ILI) was defined as “installation of a prosthetic element over an implant, without OI having occurred”. Objective: To demonstrate, through a systematic review, the clinical success rates of the immediate loading technique, present the indication criteria, and the follow-up of the procedures. Methods: This study followed the PRISMA model. Clinical studies were selected, involving retrospective, prospective and randomized studies. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. The bibliographic search was performed using online databases PubMed, Scopus, Web of Science, and Google Scholar. Results and Conclusion: A total of 135 articles were found involving immediate loading implants. A total of 78 articles were evaluated in full and 35 were included and evaluated in the present study. The analysis of the literature obtained showed that the success rates with the ILI technique are compatible with those of the late loading, as long as certain guidelines are followed, which were divided into factors related to the patient, surgical technique, implant, prosthesis, and to aesthetics. The high success rate is a consequence of correct surgical and prosthetic planning, harmony between the implant system, patient, and dentist.

Digital Versus Traditional Workflow for Immediate Loading in Single-Implant Restoration: A Randomized Clinical Trial

The purpose of this randomized controlled trial was to compare the immediate-loading protocol, in single restorations in the esthetic zone, by comparing the digital workflow in a test group (TG) vs. the analogical workflow in a control group (CG). A total of 50 patients were enrolled, requiring single hopeless tooth extraction. Twenty-five patients (TG) were randomly assigned to the immediate-loading protocol using the digital workflow, and twenty-five patients (CG) were assigned to the conventional workflow. Clinical and radiographic parameters were evaluated at the time of implant insertion (baseline) and after 3, 6 and 12 months, respectively. A clinician blind to conditions measured the Pink Esthetic Score (PES), as well as patient satisfaction. At 12-month follow-up, a cumulative survival rate of 100% was reported for all implants. No failures or biological complications were observed. No statistically significant differences were detected in the mean values of marginal bone loss and PES between the TG (0.12 ± 0.66 mm for MBL, 7.75 ± 0.89 for PES) and the CG (0.15 ± 0.54 mm for MBL, 7.50 ± 0.89 for PES). In 11 cases of TG, and 10 cases of CG, a one-year follow-up period showed an increased marginal bone level. No statistically significant differences were found in the mean total PES between test (7.75 ± 0.89) and control (7.5 ± 0.81) conditions. Furthermore, a customer satisfaction survey showed that patients preferred the digital workflow over the conventional workflow procedure (97.6 ± 4.3 vs. 69.2 ± 13.8). Digital workflow was more time-efficient than conventional workflow (97.2 ± 7.3 vs. 81.2 ± 11.3). Within the limitations of this study, no statistically significant differences were found between digital and traditional workflow.

Prosthodontic Management of Single Anterior Missing Tooth with Immediate Loading Implant Using Leukocyte-Platelet-Rich Fibrin

Immediate loading of dental implant in the anterior tooth region has been a growing trend and eliminates the compromised esthetics, function, discomfort, and inconvenience associated with traditional two-stage implant procedures. This case report presents the clinical application of implant placement with immediate loading using leukocyte-platelet-rich fibrin (L-PRF) in the anterior esthetic region. The implant was planned to rehabilitate in the anterior missing tooth region. As per the patient's desire, the implant was immediately loaded and L-PRF membrane was placed around the implant under local anesthesia on the day of surgery. The use of L-PRF for the maintenance of crestal bone and soft tissue at the implant sites provided an adequate clinical condition for better esthetics.

CLINICALLY EVALUATED ACCURACY OF SINGLE GUIDED IMPLANTATIONS WITH TWO DIFFERENT SYSTEMS – PRELIMINARY RESULTS

Introduction: Guided single implant placement ensures an optimal implant position, enables in-surgery immediate loading, and creates a predisposition for predictable treatment results. Aim: This article aims to present the surgical and loading protocols and assess the accuracy of two guided implant systems. Materials and methods: Ten patients missing a single molar were included. The semi-guided procedures with the two implant systems – AB Dental and Alpha Bio-Tec, were randomly assigned to each participant. The computer-assisted planning was performed with Implant Studio (3Shape, Denmark). Surgical guides and long-term, temporary, screw-retained restorations were virtually generated within the 3Shape system. Surgical appliances were printed from SG resin (Formlabs, USA), and crowns were milled from Telio CAD (Ivoclar Vivadent, Lichtenstein). Planning accuracy was evaluated based on the crown’s fit and relation to the adjacent teeth and antagonists. Results and discussion: The patients included for preliminary analysis (6 female and 4 male) were with a mean age of 33.42. The youngest was 24, and the oldest 49 years old. There were no surgical and technical complications for the period of evaluation, which ranged from 1 to 3 months. The crown’s fit was excellent in 8 cases. In two cases, minor adjustments were necessary – 1 in relation to the antagonists and 1 to the adjacent teeth. In one case, a healing screw was placed for 48 hours to facilitate adequate soft-tissue space for the Ti-base. Conclusion: The preliminary results presented in this report suggest that the clinical and laboratory protocols used for guided implantation and immediate loading are highly efficient.