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Immediate loading of dental implants

Report type: Alert
Published: 2003-03-18  Revised: 2004-05-12
Contact person SBU: Sofia Tranæus  E-mail: tranaeus@sbu.se

Findings by SBU Alert

This is a translation of version 1 published on March 18, 2003. The latest version of this report is not available in English.

Technology and target group

Since the 1980s, bone-anchored dental implants have become an established treatment method for replacing missing teeth. The original method is a two-stage method in which the different components are implanted during two separate surgical procedures with an interim healing time of 3 to 6 months. The total treatment time - including a possible healing period of 3 to 6 months following the removal of teeth that are not treatable – may be up to 12 months. In recent years, various attempts have been made to simplify the process and shorten the treatment time. A one-stage method has been developed whereby all of the components are installed during the same surgical procedure. Furthermore, the healing time prior to loading, ie, when the prosthetic construction is attached to the implant, has been shortened. Immediate loading means that a fixed prosthesis (a crown or bridge) is attached to the implant within 3 weeks. In Sweden, individuals aged 30 to 69 years are estimated, on average, to have approximately five teeth missing. In the group aged 70 years and older (in Sweden, nearly 1.2 million people in 2001) approximately 75 percent are estimated to have fewer than ten of their original teeth. Nearly 3 percent of the total adult population are estimated to be completely edentulous. At least 20 percent of those who are missing one or more teeth are estimated to comprise the target group for bone-anchored dental implants of some type.

Patient benefit

Several small scientific studies have compared immediate loading of implants with the conventional two-stage method in treating patients with completely edentulous lower jaws. Similar results have been reported in both groups. However, corresponding studies have not been conducted on patients with completely edentulous upper jaws, on partial bridges in partially edentulous jaws, or on single-tooth implants. No assessments were identified that included aspects related to the quality of life, eg, pain and discomfort from treatment. Likewise, no studies were found that addressed patients satisfaction with treatment results.

Economic aspects

Treatment using one-stage surgery and immediate loading of implants reduces treatment time and reduces the number of visits compared to the two-stage method, which would indicate a lower actual cost. The gross price for implant treatment is currently estimated to range between 18 000 SEK (single implant) and 85 000 SEK (total jaw), depending on the scope of the procedure. Since there is little knowledge about the effects on various indications and about the prevalence of complications and side effects, it is not possible to estimate the cost effectiveness of immediate loading of dental implants.

Scientific evidence

Currently, there is moderate* scientific documentation concerning the effects of the method in treating patients with completely edentulous lower jaws. There is poor* scientific documentation regarding immediate loading of implants in completely edentulous upper jaws, partial bridges in partially edentulous jaws, or single-tooth implants. In cases other than in completely edentulous lower jaws, the method should be used only within the framework of controlled scientific trials. There is no* scientific documentation on the cost effectiveness of the method.

*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.

This summary is based on a report prepared at SBU in collaboration with Assoc. Prof. Göran Gynther, Specialist Centre for Dental Implants, Nacka, Sweden & Department for Oral and Maxillofacial Surgery, Karolinska Institutet, Huddinge University Hospital. It has been reviewed by Assoc. Prof. Per Åstrand, The University Hospital of Linköping. The following corporations were given the opportunity to review and comment on the manuscript: Astra Tech AB, Nobel Biocare AB and Straumann AB.

The complete report is available only in Swedish.

Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.

References

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