Immediate loading of tapered implants placed in postextraction sockets: retrospective analysis of the 5-year clinical outcome

The use of immediate implant loading protocols delivers obvious benefits to the patient. When applied in healed sites, this has not only been well documented in the totally edentolous mandible but has also been documented and reported to be predictable in the upper jaw, and in cases of partial edentoulism, as well. A further application of immediate loading protocol, although still controversial, especially when replacing single maxillary teeth in the anterior zone, is the immediate implant placement and provisionalization in postextractive sockets. In consideration of the oxidized surface promoting bone healing and the tapered shape of the implant body, the Replace Select Tapered TiUnite implants have been used for many years in our clinic when facing these clinical situations. This article will report about our long-term clinical experience with such implants and the relevant role of a correct surgical and prosthetic treatment planning.

The aim of this retrospective study was to report on the 5-year clinical and radiologic outcome of patients treated with Replace Select Tapered TiUnite implants when used according to an immediate loading protocol in postextraction sites.

In routine practice, 56 consecutive patients were treated with 79 implants. The patients, 23 males and 33 females, had a mean age of 50.9 years, range 21-76 years, at implant placement. Forty-seven implants were placed in the maxilla and 32 implants were placed in the mandible. All implants were placed in postextraction sites and were immediately loaded. Provisional restorations were delivered within 2 hours from surgery and all were in occlusion. Forty-three patients received a single implant while in the remaining 13 patients the implants were splinted. Definitive prosthetic restoration was delivered within 1 to 4 months following implant placement. Evaluations of soft tissue health and marginal bone remodeling were conducted. An independent radiologist performed the radiographic evaluation using the top of the implant as the reference point with negative values indicating a level below the reference point.

Forty-eight patients, accounting for 66 implants, have passed the 5-year follow-up. No implants have failed resulting in a 5-year cumulative implant survival rate of 100%. Three patients, with six implants, withdrew during the course of the follow-up; one patient passed away and two patients moved. Five patients with seven implants did not show up at 5 years recall. At the 5-year follow-up, majority of the implants that were followed demonstrated normal periimplant mucosa and no visible plaque. The mean bone level at 5-year follow-up was -2.45mm (SD 1.29, n=63) demonstrating a level in line with the first thread. Mean marginal bone loss from implant inserting to 5 years was 0.56 mm (SD 1.98, n=63). In regard with complications, a fracture of the ceramic crown was reported 5 years after implant insertion in a patient who developed bruxism. No other biologic nor mechanical complications were reported.

This retrospective 5-year follow-up study of 56 patients treated with implants immediately placed in postextraction sockets and immediately loaded demonstrates good treatment outcome with regard to implant survival, soft tissue condition, and marginal bone response.