Considerations preliminary to the application of early and immediate loading protocols in dental implantology

Aim of the study

Apart from the empirical considerations of a few clinical cases, the authors of this article offer a comprehensive review of studies showing the results of immediate and early loading of endosseous dental implants.

Materials and methods

At the outset, the authors challenge the well-founded concept decreed by Brånemark more than 20 years ago : early loading in a risk situation (60 % of patients showing significant bone resorption, poor trabecular and cortical bone), unfinished implant design (22 types developed during the course of the study), failure to apply Brånemark's principles or those of atraumatic and aseptic surgery that we know today.

Results

The authors included in their review 22 clinical studies with recall periods of from 1 to 10 years. They deciphered the main features of each protocol to determine factors influencing early or immediate loading. From the prosthetic point of view, they noted the significance of the prosthesis, whether an overdenture, splinting and clinically the necessity to reduce the forces applied to the implant during the healing period so as not to exceed micromovements of 30 µm.

The importance of an unpolished surface is finally developed, as well as the use of a calcium phosphate type of bioactive coating whose role as an accelerator in the healing process and as a space occupier in the healing process in connection with titanium, is recalled.

Conclusion

Today, early or immediate loading is no longer a clinical decision which is totally opposed, without foundation, to the strict specifications enunciated by Brånemark. A good selection of cases must allow this type of protocol to be developped along making oral rehabilitation and delays most acceptable to the patient.

Commentary

With over 90 references, this article is a useful focus in a confusion of isolated clinical cases which have been published and of miraculous implants which suggest to us that we can apply early or immediate loading. A deeper reading shows that it is not the abutment used which causes success or failure, but attention to all the parameters involved in the rehabilitation of the case, which include just as much the quality of bone in the treatment area, the type of coating and the design of the implant, atraumatic surgery, as well as the quality of the prosthetic superstructure.