Five-year prospective study of immediate/early loading of fixed prostheses in completely edentulous jaws with a bone...

The concept of immediate loading of root-form implants for fixed restorations has received increasing interest over the last 5 years. Several authors have commented on parameters that may influence results, including implant number, implant length, bone density, and patient habits. The trigger for bone remodeling around an implant may occur from the surgical trauma of insertion or the mechanical environment of strain at the interface. In the classic two-stage approach, these were divided episodes, separated by 3 to 6 months. Immediate loading compresses this time frame; the two driving mechanisms for bone repair occur concurrently. A scientific approach to the interface development is to match the bone healing response of trauma (woven bone of repair) to the response of mechanical load (reactive woven bone), so the sum of these two entities does not result in fibrous tissue formation and clinical mobility of the implant.

It is the purpose of this article to review the scientific rationale of these statements and coordinate them to bone physiology and bone biomechanics.

Findings from previous reports in the literature were reviewed and summarized to form the basis of a prospective study using a bone quality-based implant system (Biohorizons, Maestro Dental Implants, Birmingham, AL, USA). A transitional prosthesis was delivered either on the day of surgery or within 2 weeks for 30 patients and 31 arches. A total of 244 implants were used to support these restorations, for an average of 7.8 implants per prosthesis. After 4 to 7 months, the final restorations were fabricated. One year after the final restoration was loaded, the implant survival was 100%; the 31 restorations also had a survival of 100% over this time frame. This report presents these implants and restorations over a 1- to 5-year period, with an average follow-up period of 2.6 years.

The bone loss from implant insertion to final prosthesis delivery averaged 0.7 mm. The first-year bone loss after final prosthesis delivery averaged 0.07 mm. A slight increase in bone height was observed after the first year, but generally no increase was observed over the remaining evaluation period.

In the current report, no implant failure occurred, and crestal bone loss values were similar to or less than values reported with the conditional two-stage approach. This may be related to the number and position of implants, implant design, and/or the surface condition of the implant loading.