Interventions for replacing missing teeth: different times for loading dental implants.
BACKGROUND
To minimize the risk of implant failure, osseointegrated dental implants are conventionally kept load-free during the healing period. During healing removable prostheses are used, however many patients find these temporary prostheses rather uncomfortable and it would be beneficial if the healing period could be shortened without jeopardizing implant success. Nowadays immediately and early loaded implants are commonly used in mandibles (lower jaws) of good bone quality. It would be useful to know whether there is a difference in success rates between immediately or early loaded implants compared with conventionally loaded implants.


OBJECTIVE
To evaluate the efficacy of (1) immediate (within 1 week), early (between 1 week and 2 months), and conventional (after 2 months) loading of osseointegrated implants, and of (2) immediate occlusal versus non-occlusal loading during the bone healing phase.


METHODS
The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. Handsearching included several dental journals. Authors of all identified trials, an Internet discussion group and 55 dental implant manufacturers were contacted to find unpublished randomised controlled trials (RCTs). The last electronic search was conducted on 4 June 2008.


METHODS
All RCTs of root-form osseointegrated dental implants, having a follow up of 4 months to 1 year, comparing the same implant type immediately, early and conventionally loaded or occlusally and non-occlusally loaded. Outcome measures were: prosthesis and implant failures and radiographic marginal bone level changes.


METHODS
Data were independently extracted, in duplicate, by two review authors. Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Collaboration's statistical guidelines were followed.


RESULTS
Thirty RCTs were identified and 22 trials including 976 participants in total were included. Twelve trials compared immediate versus conventional loading, three early versus conventional loading, six immediate versus early loading, and one occlusally versus non-occlusally loaded implants. On a patient, rather than per implant basis, there were no statistically significant differences for any of the meta-analyses.


CONCLUSIONS
It is possible to successfully load dental implants immediately or early after their placement in selected patients, though not all clinicians may achieve optimal results. It is unclear whether it is beneficial to avoid occlusal contacts during the osseointegration phase. Trends suggest that immediately loaded implants fail more often than those conventionally loaded, but less commonly than those loaded early. If a clinician wishes to load the implants early, it might be wiser to load them immediately (within 1 week) rather than waiting for 1 or 2 months. A high degree of primary implant stability (high value of insertion torque) seems to be one of the prerequisites for a successful immediate/early loading procedure. More well designed RCTs are needed and should be reported according to the CONSORT guidelines (www.consort-statement.org/).
Esposito
Marco
M
Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH. espositomarco@hotmail.com
Grusovin
Maria Gabriella
MG
Achille
Hubert
H
Coulthard
Paul
P
Worthington
Helen V
HV
D015519:Bone Density; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D006801:Humans; D008334:Mandible / Q000502:physiology; D008422:Materials Testing; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016388:Tooth Loss / Q000601:surgery*
D015921:Dental Implants