title: Early loading of implants with fixed dental prostheses in edentulous mandibles: 4.5-year clinical results from a prospective study.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the survival and success of early-loaded implants placed in the intraforaminal area of the edentulous mandible, and the survival of the implant-supported fixed dental prostheses (FDP).
  
  
  METHODS
  Thirty-seven patients (18.9% male, mean age 64.5 years) with edentulous lower jaws were treated with implant-supported FDPs in the mandible. One hundred and eighty-five screw-type implants were placed in the intraforaminal area of the symphysis (five implants per patient). Immediately after implant placement, a framework was fabricated and the FDP was manufactured on the framework. Within 2 weeks, the implants were rigidly connected and loaded with the implant-retained FDP.
  
  
  RESULTS
  During the 1-8-year observation period (mean 4.5 years), a total of 32 implant-retained complications occurred. Nineteen implants were lost in 10 patients, resulting in a cumulative survival of 89.7%. Nine implants in five patients did not osseointegrate. Although these implants were not removed, because stability within the connective tissue was acceptable and inflammation was absent, they were recorded as unsuccessful. Consequently, the cumulative success declined to 84.9%. Four implants in three patients had clinical signs of periimplantitis (2.2% of all implants). Denture-related complications included one complete failure, when one FDP had to be removed after the last of five implants had been replaced. Furthermore, 10 fractures of the framework occurred in six patients, three FDPs had to be adapted or modified, and the facing of the FDP had to be repaired 16 times in 11 patients.
  
  
  CONCLUSIONS
  Although one-stage early-loaded implants functioned well for most patients with edentulous mandibles, immediate loading is associated with a larger number of implant-related complications than in other studies investigating delayed loading. Because of the substantial prosthetic complications and aftercare, this procedure cannot be generally recommended.
authors.affiliation: Department of Prosthodontics, University of Heidelberg, Heidelberg, Germany. stefanie.schwarz@med.uni-heidelberg.de
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schwarz
authors.forename: Olaf
authors.initials: O
authors.lastname: Gabbert
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Hassel
authors.forename: Marc
authors.initials: M
authors.lastname: Schmitter
authors.forename: Christiane
authors.initials: C
authors.lastname: Séché
authors.forename: Peter
authors.initials: P
authors.lastname: Rammelsberg
mesh_terms: D003758:Dental Implantation, Endosseous / Q000379:methods*; D019094:Dental Prosthesis, Implant-Supported / Q000009:adverse effects*; D019232:Dental Restoration Failure; D003799:Dental Stress Analysis; D003825:Denture, Complete, Immediate / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007575:Jaw, Edentulous / Q000534:rehabilitation*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008334:Mandible / Q000601:surgery; D008875:Middle Aged; D010518:Periodontitis / Q000209:etiology; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000209:etiology; D013997:Time Factors