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Published on: October 18, 2021
Multicenter randomized clinical trial: early loading of implants in maxillary bone.
Bilal Al-Nawas1, Frank Krummenauer, André Büchter
1Medical director, Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center of the J. Gutenberg University, Mainz, Germany; head of department, Department of Medical Biometry and Epidemiology, Faculty for Health, Witten/Herdecke University, Witten, Germany; private practice, Münster, Germany; medical director, Department of Cranio-Maxillofacial Surgery, University Hospital Muenster, Muenster, Germany; head of department, Department of Maxillofacial Surgery, University of Erlangen, Erlangen, Germany; private practice, Stuttgart, Germany; medical director, Department of Maxillofacial Surgery, University of Erlangen, Erlangen, Germany; head of department, Department for Oral and Maxillofacial Surgery, Katharinenhospital, Stuttgart, Germany; head of department, Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center of the J. Gutenberg University, Mainz, Germany.
Dental implants loaded after 4 weeks showed similar success rates to those loaded after 12 weeks in the maxilla. This study found prognostic equivalence, suggesting early loading is a viable option for dental implant success.
Area of Science:
- Oral and Maxillofacial Surgery
- Dental Implantology
- Biomaterials Science
Background:
- Early loading protocols for dental implants aim to reduce treatment time.
- The maxilla presents unique challenges for osseointegration due to its anatomical and physiological characteristics.
- Standard sand-blasted, large-grid, acid-etched (SLA) surface implants are commonly used in clinical practice.
Purpose of the Study:
- To determine the prognostic equivalence of early (4 weeks) versus conventional (12 weeks) loading of dental implants in the maxilla.
- To evaluate implant success rates and failure patterns between the two loading groups.
Main Methods:
- A randomized multicenter prospective controlled clinical trial involving 104 patients and 269 SLA implants.
- Patients were assigned to either a 4-week or 12-week unloaded healing period before loading.
- Implant success was assessed at 12 months, with prognostic equivalence defined as a ±5% difference in failure rates.
Main Results:
- Implant-wise 1-year failure rates were 3.1% (4 weeks) and 3.6% (12 weeks), demonstrating statistically significant prognostic equivalence.
- Patient-wise 1-year failure rates were 6.7% (4 weeks) and 5.1% (12 weeks).
- Factors such as bone augmentation, drilling technique, bone quality, implant characteristics, and restoration fixation did not significantly impact outcomes, while trial site, posterior jaw region, and splinting were associated with higher failure rates.
Conclusions:
- Loading SLA implants in the maxilla at 4 weeks versus 12 weeks results in statistically equivalent failure patterns within a 1-year follow-up.
- Early loading (4 weeks) is a prognostically equivalent option to conventional loading (12 weeks) for maxillary implants.
- Further investigation into patient-specific factors influencing early loading success is warranted.
