Simplified methods of implant treatment in the edentulous lower jaw. Part II: Early loading.
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.
Engquist
Bo
B
Department of Prosthodontics, Public Dental Health Care, Linköping and Norrköping, Sweden. Bo.Engquist@lio.se
Astrand
Per
P
Anzén
Bengt
B
Dahlgren
Simon
S
Engquist
Eva
E
Feldmann
Hartmut
H
Karlsson
Ulf
U
Nord
Per Guńnar
PG
Sahlholm
Sten
S
Svärdström
Pia
P
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
D015921:Dental Implants; D016876:Metal Ceramic Alloys; C077451:Procera; D003776:Dental Porcelain; D014025:Titanium