title: Simplified methods of implant treatment in the edentulous lower jaw. Part II: Early loading.
abstract: BACKGROUND
  Most implant treatment is performed with a two-stage surgical procedure. A disadvantage of these implant treatments is that they are time-consuming.
  
  
  OBJECTIVE
  The aim of the present study was to evaluate the results of early loading in the edentulous mandible and to compare those results with treatment results of one-stage surgery followed by a healing period and with two-stage surgery.
  
  
  METHODS
  The material comprises four treatment groups with a total of 108 patients with edentulous lower jaws and 432 implants. All patients were treated with Brånemark implants (Nobel Biocare AB, Gothenburg, Sweden) with a turned surface and fixed prostheses in the lower jaw, supported by four implants. The patients in group A were treated with a one-stage procedure, a two-piece implant, and a 3-month healing period before loading. Group B (control group) had a two-stage procedure, a two-piece implant, and a 3-month healing period. Group C had a one-stage procedure, a one-piece implant, and a 3-month healing period. Group D was treated with a one-stage surgical procedure, a two-piece implant, and early loading (within 3 weeks). All patients were provided with a Procera Implant Bridge (Nobel Biocare) with a framework made by computer-assisted milling of one piece of pure titanium. All patients have been followed up for 1 year.
  
  
  RESULTS
  The survival rates were 93.2 to 93.3% in the experimental groups and 97.5% in the control group. The difference was not statistically significant. The measurements of the marginal bone level demonstrated a mean bone loss of 0.8 mm between fixture insertion and the 1-year examination in patients with early loading (group D) whereas the bone loss in patients who underwent a healing period before loading was 1.3 to 1.6 mm. The difference between the control group and the group with early loading was significant.
  
  
  CONCLUSIONS
  Survival rates for patients treated with a one-stage procedure were lower than survival rates for patients treated according to a "classical concept," but the differences were not statistically significant. There was no difference between treatment results with one-piece and two-piece implants. The implant loss in patients with early loading was probably caused by overloading, and careful supervision of occlusal loading is recommended. Early loading gave significantly less marginal bone loss when compared with two-stage surgery.
authors.affiliation: Department of Prosthodontics, Public Dental Health Care, Linköping and Norrköping, Sweden. Bo.Engquist@lio.se
authors.forename: Bo
authors.initials: B
authors.lastname: Engquist
authors.forename: Per
authors.initials: P
authors.lastname: Astrand
authors.forename: Bengt
authors.initials: B
authors.lastname: Anzén
authors.forename: Simon
authors.initials: S
authors.lastname: Dahlgren
authors.forename: Eva
authors.initials: E
authors.lastname: Engquist
authors.forename: Hartmut
authors.initials: H
authors.lastname: Feldmann
authors.forename: Ulf
authors.initials: U
authors.lastname: Karlsson
authors.forename: Per Guńnar
authors.initials: PG
authors.lastname: Nord
authors.forename: Sten
authors.initials: S
authors.lastname: Sahlholm
authors.forename: Pia
authors.initials: P
authors.lastname: Svärdström
mesh_terms: D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000209:etiology; D017076:Computer-Aided Design; D003758:Dental Implantation, Endosseous / Q000009:adverse effects / Q000379:methods*; D015921:Dental Implants; D003776:Dental Porcelain; D017267:Dental Prosthesis Design; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D003799:Dental Stress Analysis; D003826:Denture, Complete, Lower; D005260:Female; D006801:Humans; D007575:Jaw, Edentulous / Q000534:rehabilitation*; D008297:Male; D008334:Mandible; D016876:Metal Ceramic Alloys; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D014025:Titanium; D016474:Weight-Bearing
chemical_list: D015921:Dental Implants; D016876:Metal Ceramic Alloys; C077451:Procera; D003776:Dental Porcelain; D014025:Titanium