Interventions for replacing missing teeth: different times for loading dental implants

Esposito M, Grusovin MG, Achille H, Coulthard P, Worthington HV

Published Online:

October 7, 2009

Some people may be able to have artificial teeth attached to dental implants immediately instead of having to wait for months, but more research is needed to be sure.
When people have dental implants in their jaws, they wait several months for the bone around the implants to heal before artificial teeth are attached (using removable dentures in the meantime). If artificial teeth could be loaded onto the implant immediately, people might be able to start chewing comfortably the same day or within weeks. The review found some evidence from studies that immediate or early loading of artificial teeth may have a slightly poorer outcome than conventional (after waiting for several months) loading. However, it is possible to successfully load dental implants immediately or early after their placement in selected people, although not all clinicians may obtain such good results.

Abstract (click to read)

Background:

To minimize the risk of implant failure, osseointegrated dental implants are conventionally kept load-free during the healing period. During healing removable prostheses are used, however many patients find these temporary prostheses rather uncomfortable and it would be beneficial if the healing period could be shortened without jeopardizing implant success. Nowadays immediately and early loaded implants are commonly used in mandibles (lower jaws) of good bone quality. It would be useful to know whether there is a difference in success rates between immediately or early loaded implants compared with conventionally loaded implants.

Objectives:

To evaluate the efficacy of (1) immediate (within 1 week), early (between 1 week and 2 months), and conventional (after 2 months) loading of osseointegrated implants, and of (2) immediate occlusal versus non-occlusal loading during the bone healing phase.

Search strategy:

The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. Handsearching included several dental journals. Authors of all identified trials, an Internet discussion group and 55 dental implant manufacturers were contacted to find unpublished randomised controlled trials (RCTs). The last electronic search was conducted on 4 June 2008.

Selection criteria:

All RCTs of root-form osseointegrated dental implants, having a follow up of 4 months to 1 year, comparing the same implant type immediately, early and conventionally loaded or occlusally and non-occlusally loaded. Outcome measures were: prosthesis and implant failures and radiographic marginal bone level changes.

Data collection and analysis:

Data were independently extracted, in duplicate, by two review authors. Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Collaboration's statistical guidelines were followed.

Main results:

Thirty RCTs were identified and 22 trials including 1024 participants in total were included. Twelve trials compared immediate versus conventional loading, three early versus conventional loading, six immediate versus early loading, and one occlusally versus non-occlusally loaded implants. On a patient, rather than per implant basis, there were no statistically significant differences for any of the meta-analyses.

Authors' conclusions:

It is possible to successfully load dental implants immediately or early after their placement in selected patients, though not all clinicians may achieve optimal results. It is unclear whether it is beneficial to avoid occlusal contacts during the osseointegration phase. Trends suggest that immediately loaded implants fail more often than those conventionally loaded, but less commonly than those loaded early. If a clinician wishes to load the implants early, it might be wiser to load them immediately (within 1 week) rather than waiting for 1 or 2 months. A high degree of primary implant stability (high value of insertion torque) seems to be one of the prerequisites for a successful immediate/early loading procedure. More well designed RCTs are needed and should be reported according to the CONSORT guidelines (www.consort-statement.org/).

This record should be cited as:

Esposito M, Grusovin MG, Achille H, Coulthard P, Worthington HV. Interventions for replacing missing teeth: different times for loading dental implants. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD003878. DOI: 10.1002/14651858.CD003878.pub4

Assessed as up to date:

October 31, 2008

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Oral & maxillofacial surgery > Implants/prosthesis

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Interventions for replacing missing teeth: different times for loading dental implants

More like this

Copyright © 2012 - The Cochrane Collaboration