Immediate functional loading of TiOblast dental implants in full-arch edentulous maxillae: a 3-year prospective study

Immediate functional loading of dental implants for full-arch restoration is a patient-friendly approach, shown to be feasible with a good long-term prognosis in a completely edentulous mandible. For the complete restoration of the maxilla, acceptable long-term clinical follow-up is lacking or based on case reports rather than on prospective studies.

This prospective mono-centre study reports the 3-year outcome of immediately functionally loaded Astra Tech Dental implants in completely edentulous maxillae based on clinical survival and success based on radiographical assessment of bone level.

One hundred and ninety-five Astra Tech TiOblast surface fixtures were installed in 25 consecutively treated patients (age range: 42-76 years), of whom eight were smokers, 12 had a confirmed history of periodontitis and six had poor bone quality normally deemed for delayed loading. Fixtures and abutments were inserted in a one-stage procedure and functionally loaded within 24 h with a 10-unit provisional glass-fibre or metal-reinforced screw-retained restoration. After 6 months, each implant was checked for stability using a manual torque of 20 N cm and the provisional restoration was replaced by a 10-12-unit screw-retained metal-ceramic or metal-resin cantilever bridge. Bone level was assessed radiographically from the day of surgery up to 3 years and used to calculate mean bone loss at the patient level and individual implant success.

No failures occurred in implants or prostheses, the total survival rate being 100%. Mean marginal bone loss was 0.58 mm (SD 0.58); 0.6 mm (SD 0.53); 0.63 (SD 0.61); and 0.72 (SD 0.63) after 6 and 12 months, and 2 and 3 years, respectively, yielding a 100% success at the patient level. Wilcoxon's signed ranks test showed only statistically significant bone loss between baseline and 6 months and a steady-state condition during all other intervals. At the individual fixture level, 82% lost <1 mm marginal bone between baseline and 1 year. After 3 years, 86% have <1.5 mm total bone loss and can be considered a success. The fixtures expressing more bone loss were all inserted in smokers.

Immediate loading of a full-arch maxillary bridgework on 7-9 Astra Tech TiOblast implants is a predictable treatment option with 100% fixture survival and stable bone-to-implant contact up to 3 years. The steady state in bone remodelling is indicative of a good long-term prognosis in non-smokers but smokers seem to be more prone to bone loss.