27 April 2021

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Immediate versus early or conventional implant loading

Alessandra Abbà

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The conventional protocol for dental implant therapy-introduced by Brånemark- provides for a submersion period without any load for 3 to 4 months in the mandible and 6 to 8 months in the maxilla. The reason for the delayed implant loading was to avoid micro-movement on the implant, which could interfere with the healing process. This timing should let soft and hard tissue complete the healing after implant placement and is required to achieve osseointegration.

Recently it was suggested that it would be possible to reduce the period between the placement of the implant and the placement of the prosthesis. So immediate implant loading protocols became popular.

This technique offers advantages, such as shortening treatment duration.  However, immediate implant loading has been associated with some risk and complications.  

The differences between immediate, early, and delayed implant loadingare unclear because of the heterogeneity of the results of systematic review and meta-analysis.

The purpose of this study was to compare the efficacy of immediate implant loading versus early or delayed implant loadingimplants in patients rehabilitated with fixed prostheses.

Material and methods: A prospective protocol was developed according to the PRISMA recommendations and the PICOS strategy was used for the search. Up to October 2018, a comprehensive electronic search was conducted in CENTRAL, EMBASE, MEDLINE via PubMed and supplemented by manual searches. In the end, only human RCTs were included. Survival rate, marginal bone level changes, peri-implant gingival level, probing depth, and implant stability were set as outcomes.

Results: This systematic review included 39 RCTs, with a total of 1868 patients and 3746 implants.

 As regard marginal bone level changes, peri-implant gingival level, probing depth, and implant stability, no statistically significant differences were observed when comparing immediate versus early or delayed implant loading (P>.05). Nevertheless a statistically significant lower survival rate was registered in thedelayed implant loading. 

Conclusions: data from this study showed that compared with early loading implants, immediate implant loading could achieve comparable results. While compared withdelayed implant loading, immediate implant loading was associated with a higher incidence of implant failure but similar marginal bone level change or probing depth.

For additional information: Immediate versus early or conventional loading dental implants with fixed prostheses: A systematic review and meta-analysis of randomized controlled clinical trials