Review
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Implants loading, delayed versus immediate loading protocols: a literature review. Dana Piek DMD, Noga Harel DMD, Shiri Livne DMD, Zeev Ormianer DMD*
Osseointegrated dental implants traditionally have been placed in accordance with 2-stage protocol. This method dictated that the implant should be submerged and left to heal for a period of 3 to 4 month in mandibles and 6 month in maxillae, according to Branemark’s protocol. Removable prosthesis in frequently used during implant healing period, though uncomfortable and requires maintenance and alterations. Both patient and dentist will benefit if healing period could be shortened without jeopardizing implant success rate. Branemark requirements for healing period was based on his trials with challenging patients, simultaneously involving poor bone quality and quantity with non optimized implant and prosthesis design. Gradually, clinicians considered to shorten healing period in more standard situations, mainly using methods that limit implant micromotion under the critical threshold of 150 and up. The protocols often mentioned are the immediate and early loading. These protocols exhibit survival rates similar to the conventional loading in the short term, but it seems that the difference might be revealed when a longer followup period will be available. Both protocols require careful patient selection aimed to achieve the best primary stability. The objective of this article is to review immediate and early loading definitions and protocols. (J Osteol Biomat 2012; 1:5-11)
Keywords: early loading, immediate loading, progressive loading, edentulous mandible, edentulous maxilla, dental implants, loading protocols, partial edentulism.
Lecturer, Dept. of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel Correspondence to *Zeev Ormianer, DMD, Dept. of Oral Rehabilitation, School of Dental Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978 Israel email: ormianer@post.tau.ac.il Tel: +972-3-6124224 Fax: +972 (03)-6124226
INTRODUCTION Currently, treatment of edentulous patients using dental implants is a common practice. The ability to include dental implants in the treatment plan can facilitate dentists to overcome problems of missing teeth, extensive or localized, but it also compels them to deal with technical complexity of implant supported restorations. In addition, a treatment plan that involves dental implants might take a additional time due to healing periods required for osseointegration. This process can be delayed further if bone augmentation and/or vertical or horizontal bone grafting is needed. On 1977 Branemark published his ten year follow up concerning dental implants, this article made a revolution regarding implant loading protocols4. Until then, it was common to load an implant immediately after implantation, assuming that stimulation of the bone will prevent the alveolar bone resorption. The fibrotic layer often seen between implant and bone was a desirable feature indicating a successful outcome, imitating the PDL. Branemark introduced his strict protocol to the dental world, this protocol included a list of demands, and the most important were: 1) use of a biocompatible material i.e. titanium; 2) use of a
Volume 3 - Number 1 - 2012