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Published on: October 18, 2021
Clinical outcomes of immediate versus early or conventional loading of single implants: A de novo RCT-level
Aspasia Pachiou1, Franz J Strauss2, Eirini Pagkalidou3
1Academic Associate, Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland.
Statement Of Problem:
Immediate loading of single implants has been widely used to reduce treatment time and improve patient convenience. However, uncertainty remains regarding its long-term survival, marginal bone stability, and prosthetic reliability compared with early or conventional loading protocols.
Purpose:
The purpose of this study was to synthesize the available randomized controlled trial (RCT) evidence comparing immediate loading with early or conventional loading of single implants, using trial-level meta-analysis with contextual evaluation of existing systematic reviews.
Material And Methods:
Electronic searches of the PubMed, Embase, Scopus, Epistemonikos, and Cochrane databases were conducted through October 2025. Systematic reviews restricted to RCTs were identified, and all eligible primary RCTs were re-extracted to avoid double counting. Overlap among reviews was quantified with the Corrected Covered Area. Random-effects meta-analyses were performed to calculate risk ratios (RR) for implant survival and complications, mean differences (MD) for marginal bone loss (MBL), and standardized mean differences (SMD) for patient-reported outcomes. Follow-up intervals were analyzed separately (1, 2, 3, and 5 years). The certainty of evidence was assessed with GRADE.
Results:
Seven systematic reviews and 2 additional RCTs were identified, yielding 40 unique trials and more than 1200 single implants with follow-up ranging from 1 to 10 years. Evidence overlap among reviews was high (CCA=11.5%). No statistically significant differences were found in implant survival between immediate and conventional loading at 1 year (RR=1.00; 95% CI, 0.98 to 1.02), 2 years (RR=1.01; 95% CI, 0.96 to 1.05), 3 years (RR=1.01; 95% CI, 0.97 to 1.05), or 5 years (RR=1.00; 95% CI, 0.97 to 1.03), nor between immediate and early loading at 1 year (RR=0.99; 95% CI, 0.96 to 1.02). Differences in MBL were minimal and clinically negligible at all time points. Patient satisfaction did not differ significantly between protocols, and prosthetic and biologic complications were infrequent in both groups. The certainty of evidence was moderate for survival and low to very low for secondary outcomes.
Conclusions:
When applied under appropriate clinical conditions, immediate loading of single implants demonstrated survival, marginal bone stability, complication rates, and patient satisfaction comparable to early or conventional loading.
