Immediate loading of dental implants

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SBU Assessment

Presents a comprehensive, systematic assessment of available scientific evidence for effects on health, social welfare or disability. Full assessments include economic, social and ethical impact analyses. Experts participate in the work. and the reports are reviewed by independent experts.

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Published: Revised: 5/11/2004

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

  1. Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;10(6):387-416.
  2. Adell R, Eriksson B, Lekholm U, Brånemark PI, Jemt T. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants 1990;5(4):347-59.
  3. Albrektsson T, Brånemark PI, Hansson HA, Lindström J. Osseointegrated titanium implants. Requirements for ensuring a long-lasting, direct bone-to-implant anchorage in man. Acta Orthop Scand 1981;52(2):155-70.
  4. Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants 1986;1(1):11-25.
  5. Andersen E, Haanaes HR, Knutsen BM. Immediate loading of single-tooth ITI implants in the anterior maxilla: a prospective 5-year pilot study. Clin Oral Implants Res 2002;13(3):281-7.
  6. Arvidson K, Bystedt H, Frykholm A, von Konow L, Lothigius E. Five-year prospective follow-up report of the Astra Tech Dental Implant System in the treatment of edentulous mandibles. Clin Oral Implants Res 1998;9(4):225-34.
  7. Balkin BE, Steflik DE, Naval F. Mini-dental implant insertion with the auto-advance technique for ongoing applications. J Oral Implantol 2001;27(1):32-7.
  8. Balshi TJ, Wolfinger GJ. Immediate loading of Brånemark implants in edentulous mandibles: a preliminary report. Implant Dent 1997;6(2):83-8.
  9. Becker W, Becker BE, Israelson H, Lucchini JP, Handelsman M, Ammons W et al. One-step surgical placement of Brånemark implants: a prospective multicenter clinical study. Int J Oral Maxillofac Implants 1997;12(4):454-62.
  10. Bohsali K, Simon H, Kan JY, Redd M. Modular transitional implants to support the interim maxillary overdenture. Compend Contin Educ Dent 1999;20(10):975-80.
  11. Brunski JB. In vivo bone response to biomechanical loading at the bone/dental-implant interface. Adv Dent Res 1999 Jun;13:99-119.
  12. Brånemark PI, Engstrand P, Öhrnell LO, Gröndahl K, Nilsson P, Hagberg K et al. Brånemark Novum: a new treatment concept for rehabilitation of the edentulous mandible. Preliminary results from a prospective clinical follow-up study. Clin Implant Dent Relat Res 1999;1(1):2-16.
  13. Buser D, Maeglin B. Complications with ITI implants. In: Schroeder A, Sutter F, Buser D, Krekeler G, eds. Oral Implantology. Basics, ITI Dental Implant System. New York: Thieme Medical Publishers, 1996:445-76.
  14. Buser D, Mericske-Stern R, Bernard JP, Behneke A, Behneke N, Hirt HP et al. Long-term evaluation of non-submerged ITI implants. Part 1: 8-year life table analysis of a prospective multi-center study with 2359 implants. Clin Oral Implants Res 1997;8(3):161-72.
  15. Cameron HU, Pilliar RM, MacNab I. The effect of movement on the bonding of porous metal to bone. J Biomed Mater Res 1973;7(4):301-11.
  16. Chaushu G, Chaushu S, Tzohar A, Dayan D. Immediate loading of single-tooth implants: immediate versus non-immediate implantation. A clinical report. Int J Oral Maxillofac Implants 2001;16(2):267-72.
  17. Chiapasco M, Gatti C, Rossi E, Haefliger W, Markwalder TH. Implant-retained mandibular overdentures with immediate loading. A retrospective multicenter study on 226 consecutive cases. Clin Oral Implants Res 1997;8(1):48-57.
  18. Chiapasco M, Abati S, Romeo E, Vogel G. Implant-retained mandibular overdentures with Brånemark System MKII implants: a prospective comparative study between delayed and immediate loading. Int J Oral Maxillofac Implants 2001;16(4):537-46.
  19. Chow J, Hui E, Liu J, Li D, Wat P, Li W et al. The Hong Kong Bridge Protocol. Immediate loading of mandibular Brånemark fixtures using a provisional prosthesis: preliminary results. Clin Implant Dent Relat Res 2001;3(3):166-74.
  20. Collaert B, De Bruyn H. Early loading of four or five Astra Tech fixtures with a fixed cross-arch restoration in the mandible. Clin Implant Dent Relat Res 2002;4(3):133-5.
  21. Colomina LE. Immediate loading of implant-fixed mandibular prostheses: a prospective 18-month follow-up clinical study - preliminary report. Implant Dent 2001;10(1):23-9.
  22. Cooper LF, Rahman A, Moriarty J, Chaffee N, Sacco D. Immediate mandibular rehabilitation with endosseous implants: simultaneous extraction, implant placement, and loading. Int J Oral Maxillofac Implants 2002;17(4):517-25.
  23. de Bruyn H, Collaert B. Early loading of machined-surface Brånemark implants in completely edentulous mandibles: healed bone versus fresh extraction sites. Clin Implant Dent Relat Res 2002;4(3):136-42.
  24. Engquist B, Åstrand P, Anzen B, Dahlgren S, Engquist E, Feldman H et al. Simplified methods of implant treatment in the edentulous lower jaw. A controlled prospective study. Part I: one-stage versus two-stage surgery. Clin Implant Dent Relat Res 2002;4(2):93-103.
  25. Ericsson I, Randow K, Nilner K, Petersson A. Some clinical and radiographical features of submerged and non-submerged titanium implants. A 5-year follow-up study. Clin Oral Implants Res 1997;8(5):422-6.
  26. Ericsson I, Nilson H, Lindh T, Nilner K, Randow K. Immediate functional loading of Brånemark single tooth implants. An 18 months´ clinical pilot follow-up study. Clin Oral Implants Res 2000;11(1):26-33.
  27. Ericsson I, Randow K, Nilner K, Peterson A. Early functional loading of Brånemark dental implants: 5-year clinical follow-up study. Clin Implant Dent Relat Res 2000;2(2):70-7.
  28. Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (II). Etiopathogenesis. Eur J Oral Sci 1998;106(3):721-64.
  29. Esposito M, Worthington HV, Coulthard P. Interventions for replacing missing teeth: different times for loading dental implants (Cochrane Review). Cochrane Database Syst Rev. 2003;(1):CD003878.
  30. Gatti C, Haefliger W, Chiapasco M. Implant-retained mandibular overdentures with immediate loading: a prospective study of ITI implants. Int J Oral Maxillofac Implants 2000;15(3):383-8.
  31. Glantz PO, Stafford GD. Clinical deformation of maxillary complete dentures. J Dent 1983;11(3):224-30.
  32. Glauser R, Ree A, Lundgren A, Gottlow J, Hammerle CH, Scharer P. Immediate occlusal loading of Brånemark implants applied in various jawbone regions: a prospective, 1-year clinical study. Clin Implant Dent Relat Res 2001;3(4):204-13.
  33. Grunder U. Immediate functional loading of immediate implants in edentulous arches: two-year results. Int J Periodontics Restorative Dent 2001;21(6):545-51.
  34. Hellem S, Karlsson U, Almfeldt I, Brunell G, Hamp SE, Åstrand P. Nonsubmerged implants in the treatment of the edentulous lower jaw: a 5-year prospective longitudinal study of ITI hollow screws. Clin Implant Dent Relat Res 2001;3(1):20-9.
  35. Henry PJ, Laney WR, Jemt T, Harris D, Krogh PH, Polizzi G et al. Osseointegrated implants for single-tooth replacement: a prospective 5-year multicenter study. Int J Oral Maxillofac Implants 1996;11(4):450-5.
  36. Horiuchi K, Uchida H, Yamamoto K, Sugimura M. Immediate loading of Brånemark system implants following placement in edentulous patients: a clinical report. Int J Oral Maxillofac Implants 2000;15(6):824-30.
  37. Isidor F. Loss of osseointegration caused by occlusal load of oral implants. A clinical and radiographic study in monkeys. Clin Oral Implants Res 1996;7(2):143-52.
  38. Jaffin RA, Kumar A, Berman CL. Immediate loading of implants in partially and fully edentulous jaws: A series of 27 case reports. J Periodontol 2000;71(5):833-8.
  39. Jemt T, Lekholm U. Oral implant treatment in posterior partially edentulous jaws: a 5-year follow-up report. Int J Oral Maxillofac Implants 1993;8(6):635-40.
  40. Kronström M, Palmqvist S, Söderfeldt B, Vigild M. Subjective need for implant treatment among middle-aged people in Sweden and Denmark. Clin Implant Dent Relat Res 2002;4(1):11-5.
  41. Lekholm U, Gunne J, Henry P, Higuchi K, Lindén U, Bergström C et al. Survival of the Brånemark implant in partially edentulous jaws: a 10-year prospective multicenter study. Int J Oral Maxillofac Implants 1999;14(5):639-45.
  42. Malo P, Rangert B, Dvärsäter L. Immediate function of Brånemark implants in the esthetic zone: a retrospective clinical study with 6 months to 4 years of follow-up. Clin Implant Dent Relat Res 2000;2(3):138-46.
  43. Moberg LE, Köndell PÅ, Kullman L, Heimdahl A, Gynther GW. Evaluation of single-tooth restorations on ITI dental Implants. A prospective study of 29 patients. Clin Oral Implants Res 1999;10(1):45-53.
  44. Moberg LE, Köndell PÅ, Sagulin GB, Bolin A, Heimdahl A, Gynther GW. Brånemark SystemÒ and ITI Dental Implant SystemÒ for treatment of mandibular edentulism. A comparative randomized study: 3-year follow-up. Clin Oral Implants Res 2001;12(5):450-61.
  45. Palmer RM, Smith BJ, Palmer PJ, Floyd PD. A prospective study of Astra single tooth implants. Clin Oral Implants Res 1997;8(3):173-9.
  46. Palmqvist S, Söderfeldt B, Arnbjerg D. Subjective need for implant dentistry in a Swedish population aged 45-69 years. Clin Oral Implants Res 1991;2(3):99-102.
  47. Petrungaro PS. Fixed temporization and bone-augmented ridge stabilization with transitional implants. Pract Periodontics Aesthet Dent 1997;9(9):1071-8.
  48. Proussaefs P, Kan J, Lozada J, Kleinman A, Farnos A. Effects of immediate loading with threaded hydroxyapatite-coated root-form implants on single premolar replacements: a preliminary report. Int J Oral Maxillofac Implants 2002;17(4):567-72.
  49. Quirynen M, De Soete M, van Steenberghe D. Infectious risks for oral implants: a review of the literature. Clin Oral Implants Res 2002;13(1):1-19.
  50. Rungcharassaeng K, Lozada JL, Kan JY, Kim JS, Campagni WV, Munoz CA. Peri-implant tissue response of immediately loaded, threaded, HA-coated implants: 1-year results. J Prosthet Dent 2002 Feb;87(2):173-81.
  51. Samuelsson R, Thorstensen S, Haanæs HR. An aesthetic approach using the Astra implant system. Presented at a precongress course at the 30th SFOMK Congress, March 7, 2002, Lillehammer, Norway.
  52. Scheller H, Urgell JP, Kultje C, Klineberg I, Goldberg PV, Stevenson-Moore P et al. A 5-year multicenter study on implant-supported single crown restorations. Int J Oral Maxillofac Implants 1998;13(2):212-8.
  53. Schnitman PA, Wohrle PS, Rubenstein JE, DaSilva JD, Wang NH. Ten-year results for Brånemark implants immediately loaded with fixed prostheses at implant placement. Int J Oral Maxillofac Implants 1997;12(4):495-503.
  54. Szmukler-Moncler S, Salama H, Reingewirtz Y, Dubruille JH. Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature. J Biomed Mater Res 1998 Summer;43(2):192-203.
  55. Tarnow DP, Emtiaz S, Classi A. Immediate loading of threaded implants at stage 1 surgery in edentulous arches: ten consecutive case reports with 1- to 5-year data. Int J Oral Maxillofac Implants 1997;12(3):319-24.
  56. Testori T, Szmukler-Moncler S, Francetti L, Del Fabbro M, Scarano A, Piattelli A et al. Immediate loading of Osteotite implants: a case report and histologic analysis after 4 months of occlusal loading. Int J Periodontics Restorative Dent 2001;21(5):451-9.
  57. van Steenberghe D, Naert I, Andersson M, Brajnovic I, Van Cleynenbreugel J, Suetens P. A custom template and definitive prosthesis allowing immediate implant loading in the maxilla: a clinical report. Int J Oral Maxillofac Implants 2002;17(5):663-70.
  58. Åstrand P, Anzen B, Karlsson U, Sahlholm S, Svärdström P, Hellem S. Nonsubmerged implants in the treatment of the edentulous upper jaw: a prospective clinical and radiographic study of ITI implants--results after 1 year. Clin Implant Dent Relat Res 2000;2(3):166-74.
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