Clinical Outcomes of Immediate Implant Loading with Fixed Prostheses in Edentulous Maxillae: A Systematic Review

To review the evidence from the clinical outcomes of immediately loaded implants with fixed prostheses in edentulous maxillae.

An electronic search was performed in PubMed/MEDLINE, Embase, and Cochrane to identify studies investigating the outcome of implants subjected to immediate loading with fixed dental prostheses in edentulous maxillae. Only clinical studies with more than 10 patients and a mean follow-up time of more than 12 months were included. Meta-analysis was utilized to compare the clinical outcomes between immediately loaded implants and conventionally loaded implants. For immediately loaded implants, a cumulative implant survival rate (ISR) was weighted by the duration of follow-up and number of implants. The weighted marginal bone loss (MBL) was also assessed.

A total of 33 studies (16 retrospective studies and 17 prospective studies) were included, which involved 2,635 patients and 12,480 implants. Meta-analysis did not reveal a significant difference of ISR or MBL between the two loading groups. For immediately loaded implants, the weighted cumulative ISR was 95.53% (median: 97.50%) with a mean follow-up of 46.07 months (SD: 30.92). Fourteen studies reported on the MBL of implants, and the mean MBL was 1.19 mm (SD: 0.88) with a mean period of 57.70 months (SD: 32.56). The results should be interpreted with caution due to the lack of randomized controlled trials (RCTs) and the heterogeneity of the data.

Despite the lack of RCTs, immediate implant loading with a fixed prosthesis in the edentulous maxilla seems to be a reliable treatment alternative with a high ISR, when appropriate inclusion/exclusion criteria are followed.