Immediate Loading in Mandible Full-Arch: Pilot Study in Patients With Osteoporosis in Bisphosphonate Therapy
This is the type of research I love finding as it has a direct impact on patient treatment. MJ
Alessandro Leonida, Paolo Vescovi, Marco Baldoni, Gabriele Rossi, and Dorina Lauritano (2012) Immediate Loading in Mandible Full-Arch: Pilot Study in Patients With Osteoporosis in Bisphosphonate Therapy. Journal of Oral Implantology: February 2012, Vol. 38, No. 1, pp. 85-94.
Alessandro Leonida, Paolo Vescovi, Marco Baldoni, Gabriele Rossi, and Dorina Lauritano (2012) Immediate Loading in Mandible Full-Arch: Pilot Study in Patients With Osteoporosis in Bisphosphonate Therapy. Journal of Oral Implantology: February 2012, Vol. 38, No. 1, pp. 85-94.
Dental implants have been used clinically in a routine manner to
restore completely edentulous mandibles. A recent systematic review of
the literature conducted by Bryant1
describes the 5-year cumulative survival rates of mandibular fixed and
removable prostheses between 83% and 100%, with corresponding levels of
crestal bone loss up to 1.1 mm the first year and 0.4 mm per year
thereafter. The author included in his review studies using the
classical two-stage surgical approach, whereby the implant is initially
covered underneath the mucosa and kept unloaded for 4–6 months.2
However, over the past decade changes in dental implant design and
surface configuration combined with an improved understanding of the
biological and biomechanical aspects have improved the clinical outcome
of implant treatments.3
These advancements have led to the one-stage surgical procedures in
conjunction with earlier loading, especially in the completely
edentulous mandible. Today there is evidence, although based on a small
number of studies and relatively low patient numbers, that immediate
loading can lead to survival rates comparable to conventionally loaded
implants.4
The ultimate goal of an immediate loading protocol is to reduce the number of surgical interventions and to decrease the timeframe between surgery and prosthetic delivery without sacrificing implant success rates. These new protocols will ultimately diminish patients' reservations and result in increased acceptance of implant therapy.
Before embracing the procedure as a routine treatment, the immediate loading technique needs to be validated with a significant number of clinical cases, extended follow-ups, and a clear definition of limitations. Because implant macrogeometry/microgeometry and the loading mode5 play a crucial role during the healing phase, it is important when documenting immediate loading cases to identify clearly the type of implant and rehabilitation used.
In two preliminary investigations, two patients treated in one of the centers of this study received both submerged and immediately loaded (IL) implants, according to a protocol adopted by Schnitman.6 The rationale for the Schnitman6 protocol was to provide the patient with a sufficient number of implants should all the IL implants fail. Both the submerged and IL implants had the hex abutment attachment placed above the bony ridge, in a so-called crestal position.7,8 These initial patients received provisional prosthesis supported by IL implants 4 hours after surgery. Following a surgical prosthetic procedure detailed in previous studies,9,10 2 submerged and 1 IL implant were retrieved after 2 months from one patient, and 2 IL implants were retrieved after 4 months from the second patient for histologic analysis. All the retrieved IL implants showed bone-to-implant contact at both timeframes, suggesting that immediate loading does not hinder implant osseointegration. Furthermore, no significant differences in crestal bone loss could be detected between the IL and submerged implants at any follow-up evaluation. As a result of these preliminary findings, we were encouraged to apply a similar protocol to a wider range of patients.
Therefore, we have set the goal of demonstrating the potential to completely rehabilitate the jaw with full-arch technique in 9 patients receiving oral bisphosphonate therapy for less than 3 years.
Read the remainder of the study...
The ultimate goal of an immediate loading protocol is to reduce the number of surgical interventions and to decrease the timeframe between surgery and prosthetic delivery without sacrificing implant success rates. These new protocols will ultimately diminish patients' reservations and result in increased acceptance of implant therapy.
Before embracing the procedure as a routine treatment, the immediate loading technique needs to be validated with a significant number of clinical cases, extended follow-ups, and a clear definition of limitations. Because implant macrogeometry/microgeometry and the loading mode5 play a crucial role during the healing phase, it is important when documenting immediate loading cases to identify clearly the type of implant and rehabilitation used.
In two preliminary investigations, two patients treated in one of the centers of this study received both submerged and immediately loaded (IL) implants, according to a protocol adopted by Schnitman.6 The rationale for the Schnitman6 protocol was to provide the patient with a sufficient number of implants should all the IL implants fail. Both the submerged and IL implants had the hex abutment attachment placed above the bony ridge, in a so-called crestal position.7,8 These initial patients received provisional prosthesis supported by IL implants 4 hours after surgery. Following a surgical prosthetic procedure detailed in previous studies,9,10 2 submerged and 1 IL implant were retrieved after 2 months from one patient, and 2 IL implants were retrieved after 4 months from the second patient for histologic analysis. All the retrieved IL implants showed bone-to-implant contact at both timeframes, suggesting that immediate loading does not hinder implant osseointegration. Furthermore, no significant differences in crestal bone loss could be detected between the IL and submerged implants at any follow-up evaluation. As a result of these preliminary findings, we were encouraged to apply a similar protocol to a wider range of patients.
Therefore, we have set the goal of demonstrating the potential to completely rehabilitate the jaw with full-arch technique in 9 patients receiving oral bisphosphonate therapy for less than 3 years.
Read the remainder of the study...
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