ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Similar Success of Immediate, Early and Conventionally Loaded Implants
Clinical Question In patients receiving dental implants, is conventional loading more successful than immediately loaded implants?
Clinical Bottom Line Immediate, early and conventionally loaded implants are equally successful as determined by implant osteointegration.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19160225Esposito/ 200930 RCTs, 22 trials, 976 ptsSystemic Review
Key resultsImmediately loaded implants tend to fail more often than conventionally loaded implants (95% CI, RR 2.41), but less often than early loaded implants. There is an association between high torque upon insertion and greater success for immediately/early placed implants.
#2) 16101355Ioannidou/200513 trials, 1,266 implantsMeta-Analysis
Key resultsThere weren't any differences found in implant failure rate amongst implant loading techniques (95% CI: 0.41 to 2.03; P=0.41). Implant failure did occur, but wasn't statistically significant, for immediately loaded implants (95% CI: 0.38 to 4.13; P=0.35). Further analysis of RCTS confirmed findings.
#3) 19820741Stafford/200919 trials, only 5 RCTsMeta-Analysis
Key resultsThis meta-analysis gave an overall survival rate of 95.5%, 95% confidence interval (93.0-97.1) after 1 year. The stratified meta-analysis did not reveal differences in survival between early, immediate, and conventional implant techniques.
Evidence Search ("Cochrane Database Syst Rev"[Journal] OR ("cochrane"[All Fields] AND "review"[All Fields]) OR "cochrane review"[All Fields]) AND immediately[All Fields] AND loaded[All Fields] AND implant[All Fields] AND conventionally[All Fields] AND loaded[All Fields] AND implant[All Fields]
Comments on
The Evidence
Two meta-analyses and a systemic review of randomized and non-randomized clinical trials regarding success of conventionally loaded and immediately loaded implants. Outcome measures were prosthesis/implant failure and radiographic marginal bone level changes. A 4-month to one-year follow-up period was used. Evidence appears internally valid, but greater attention should be given to implant location to verify external validity.
Applicability Given the success of immediately loaded implants, the associated benefits of wearing interim prosthesis for less time along with reduced bone healing times are realistic benefits. There is an association between high torque upon insertion and greater success for immediate and early placed implants. Patient selection is critical to success and not all clinicians will produce ideal results.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords Conventionally Loaded, Immediately Loaded
ID# 2299
Date of submission: 08/07/2012spacer Revised: 12/20/2012
E-mail reyesaj@livemail.uthscsa.edu
Author Ashley Reyes
Co-author(s) Sarah Norman
Co-author(s) e-mail normans@livmail.uthscsa.edu
Faculty mentor/Co-author James Piper, II, DDS
Faculty mentor/Co-author e-mail james.piper@us.af.mil
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
by Ashley Reyes (San Antonio, TX) on 09/14/2012
During osseointegration, a dynamic equilibrium occurs along the implant-bone interface (PMID: 17138420). Primary bone contact occurs immediately after implant placement. This native bone gradually decreases as secondary bone is formed after remodeling. Resonance frequency analysis measures bone stability and reveals that higher quality bone results in greater implant stability for the first 3-4 weeks of healing, since more primary bone contacts the implant upon placement and more stays in contact while secondary bone develops and matures. Bone quality must be considered before implant placement.
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