Immediate loading of two flapless placed mandibular implants supporting cross-arch fixed prostheses: A 5-year follow-up prospective single cohort study.
OBJECTIVE
To evaluate the clinical outcome of two implants placed flapless in fully edentulous mandibles and immediately restored with metal-resin screw-retained cross-arch prostheses 5 years after loading.


METHODS
Eighty consecutive patients were recruited. To be immediately loaded, implants had to be inserted with a minimum torque of 80 Ncm. Forty-six laser-welded titanium and 34 cast silver-palladium frameworks with resin teeth were initially delivered within 8 and 48 h, respectively. Outcome measures, evaluated by two independent assessors included prosthesis and implant failures, complications, marginal bone level changes, implant stability quotient (ISQ) values and patient satisfaction.


RESULTS
Five years after loading one patient did not return to the control and 10 prostheses were remade. Two implants failed early in two patients, but they were successfully replaced. Thirty-six complications occurred in 28 patients but were all successfully treated. After 5 years, mean marginal bone loss was 0.69 mm, mean ISQ values decreased from 75.4 to 73.8, and all patients were fully satisfied with the therapy. A post-hoc comparison between the outcome of laser-welded and cast frameworks showed that laser-welded frameworks were affected by significantly more complications (19 patients out of 46 and 6 patients out of 34, respectively; difference in proportion = 0.23, 95% CI: 0.03 to 0.43; Pearson's chi-square test, P = 0.032), therefore such a framework construction should be considered as a long-term temporary prosthesis and not a definitive prosthesis.


CONCLUSIONS
Immediately loaded mandibular cross-arch prostheses can be supported by only two implants up to 5 years, if made with a robust cast framework. Longer follow-ups (around 10 years) are still needed to know the prognosis of this treatment modality.
Gioacchino
G
Cannizzaro
Pietro
P
Felice
Matteo
M
Lazzarini
Vittorio
V
Ferri
Michele
M
Leone
Anna
A
Trullenque-Eriksson
Marco
M
Esposito
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000539:Alveolar Process / Q000000981:diagnostic imaging; D015331:Cohort Studies; D003722:Dental Alloys / Q000737:chemistry; D015921:Dental Implants; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D012994:Dental Soldering / Q000295:instrumentation; D003779:Denture Design; D003826:Denture, Complete, Lower; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057893:Immediate Dental Implant Loading / Q000379:methods*; D007575:Jaw, Edentulous / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D016300:Radiography, Bitewing; D016896:Treatment Outcome
D003722:Dental Alloys; D015921:Dental Implants