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Immediate or Early vs. Delayed Loading Protocols for Two-Implant Mandibular Overdentures in Edentulous Population: A
Morteza Sharifi1, Asal Rezaeiyazdi1, Mehdi Mohammadzadeh1
1Department of Prosthodontics, School of Dentistry Isfahan University of Medical Sciences Isfahan Iran.
Health Science Reports
|July 16, 2026
Summary
Immediate and early loading of two-implant mandibular overdentures show minimal marginal bone loss (MBL) compared to delayed loading. While statistically significant, the small effect size suggests no significant clinical difference in MBL for dental implant patients.
Area of Science:
- Dental Implantology
- Prosthodontics
- Biomaterials
Background:
- Edentulous patients often receive mandibular overdentures supported by dental implants.
- The optimal loading protocol (immediate/early vs. delayed) for minimizing marginal bone loss (MBL) in these restorations is uncertain.
Purpose of the Study:
- To systematically review and meta-analyze marginal bone loss (MBL) in two-implant mandibular overdentures comparing immediate/early loading versus delayed loading protocols.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) adhering to PRISMA guidelines.
- Included studies compared immediate/early loading with delayed loading in fully edentulous patients with two-implant mandibular overdentures.
- Data synthesized using random-effects meta-analysis; subgroup analyses conducted based on implant type, attachment system, and surface characteristics.
Main Results:
- Twenty-two RCTs (580 patients, 1186 implants) were included; 13 provided quantitative data for meta-analysis.
- Immediate/early loading showed significantly lower MBL than delayed loading (WMD = -0.13 mm; p=0.04), but the difference was small and likely not clinically meaningful.
- Early loading showed greater MBL reduction than delayed loading; bone-level implants and Locator attachments yielded favorable outcomes. Certainty of evidence was low to moderate.
Conclusions:
- Immediate and early loading protocols exhibit comparable clinical performance to delayed loading regarding marginal bone preservation.
- The observed statistically significant difference in MBL is unlikely to be clinically meaningful.
- Findings should be interpreted cautiously due to low to moderate evidence certainty, heterogeneity, and risk of bias.
