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Survival and complications of narrow-diameter implants supporting fixed restorations under immediate versus early or
Aspasia Pachiou1, Franz J Strauss2, Margherita Giorgia Liguori3
1Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland.
Objectives:
To evaluate implant survival and complication rates of narrow-diameter implants (NDIs) supporting fixed restorations under immediate versus early/delayed loading protocols.
Data:
Randomized controlled trials and non-randomized clinical studies reporting implant survival, marginal bone loss (MBL), biological, or prosthetic complications for immediately and early/delayed loaded NDIs were considered.
Sources:
Electronic searches of PubMed/MEDLINE, Embase, and Scopus were conducted up to January 2026. The study was conducted according to the PRISMA 2020 statement and registered prospectively in PROSPERO (CRD420250654797).
Study Selection:
Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Nine studies met the inclusion criteria for qualitative synthesis, of which seven provided sufficient data for meta-analysis. Random-effects meta-analyses were conducted when methodologically appropriate, and the certainty of evidence was assessed using the GRADE approach.
Conclusions:
Immediate loading of NDIs supporting fixed restorations may achieve implant survival outcomes comparable to early/delayed loading protocols. Short-term biological, prosthetic, and MBL outcomes appeared similar between loading strategies; however, the certainty of evidence was limited. A higher risk of long-term biological complications with immediate loading was observed, although this finding is based on limited evidence with very low certainty.
Clinical Significance:
Immediate loading of NDIs may represent a viable and time-efficient treatment option for fixed restorations in appropriately selected cases. Given the limited certainty of long-term biological outcomes, careful case selection and long-term monitoring remain essential.
