title: Immediate loading of four (all-on-4) post-extractive implants supporting mandibular cross-arch fixed prostheses: 18-month follow-up from a multicentre prospective cohort study.
abstract: OBJECTIVE
  To evaluate the outcome of immediately loaded mandibular cross-arch prostheses according to the 'all-on-4' concept supported by implants placed in fresh extraction sockets up to 18 months after loading.
  
  
  METHODS
  In total, 47 patients with a mean age of 62.3 years (range 52 to 78) were rehabilitated with an immediately loaded fixed cross-arch prosthesis supported by four post-extractive implants. A total of 188 implants were inserted. Patients received a provisional fixed dental prosthesis with a metal framework within 48 hours after surgery and a permanent one 6 months later. The patients were evaluated clinically and radiographically at implant placement and at 6-, 12- and 18-month follow-up examinations.
  
  
  RESULTS
  At the 18-month follow-up, no implant failed and all restorations were stable. Peri-implant bone levels amounted to 0.31 ± 0.12 mm after 6 months, 0.58 ± 0.112 mm after 12 months and 0.7 ± 0.107 mm after 18 months. No significant differences in bone loss were found between axially placed and tilted implants at the 6-month (0.06 mm; P = 0.115), the 12-month (0.12 mm; P = 0.062) and the 18-month follow-up (0.08 mm; P = 0.146). Three patients had a fracture of the provisional restoration, but all of the definitive prostheses remained stable throughout the study period without any complications.
  
  
  CONCLUSIONS
  Within the limits of this study, it can be suggested that immediately loaded mandibular cross-arch fixed dental prostheses can be supported by four post-extractive implants, however larger and longer follow-ups are needed.
authors.affiliation: Department of Integrated Activities of Specialised Head-Neck Surgery, University of Modena and Reggio Emilia, Italy. tommaso.grandi@unimore.it
authors.forename: Tommaso
authors.initials: T
authors.lastname: Grandi
authors.forename: Paolo
authors.initials: P
authors.lastname: Guazzi
authors.forename: Rawad
authors.initials: R
authors.lastname: Samarani
authors.forename: Giovanni
authors.initials: G
authors.lastname: Grandi
mesh_terms: D000368:Aged; D000539:Alveolar Process / Q000000981:diagnostic imaging / Q000473:pathology; D015331:Cohort Studies; D015921:Dental Implants; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D003779:Denture Design; D003825:Denture, Complete, Immediate; D003826:Denture, Complete, Lower; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057893:Immediate Dental Implant Loading; D008297:Male; D008334:Mandible / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D016348:Osseointegration / Q000502:physiology; D011446:Prospective Studies; D016300:Radiography, Bitewing; D011862:Radiography, Panoramic; D014057:Tomography, X-Ray Computed; D020390:Tooth Socket / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D015921:Dental Implants