Άμεση φόρτιση Άμεση φόρτιση εμφυτευμάτωνεμφυτευμάτων σε επένθετες σε επένθετες

οδοντοστοιχίες οδοντοστοιχίες

Στέφανος ΚούρτηςΕπικ. Καθηγητής Προσθετικής ΕΚΠΑ

Αμεση φόρτιση Αμεση φόρτιση εμφυτευμάτωνεμφυτευμάτων

• Oλική νωδότητα

- Άνω γνάθου

- Κάτω γνάθου

Μερική νωδότητα

Μονήρη εμφυτεύματα

Αμεση φόρτιση Αμεση φόρτιση εμφυτευμάτωνεμφυτευμάτων

• Oλική νωδότητα κάτω γνάθου

Πρώτη αναφορά το 1977 από το Ledermann για άμεση φόρτιση 4 εμφυτευμάτων ανάμεσα στα γενειακά τρήματα συνδεδεμένα με δοκό. Το 1996 παρουσίασε αποτελέσματα έως 20 ετών με ποσοστό επιτυχίας > 90%

• 4 εμφυτεύματα με προκατασκευασμένες τηλεσκοπικές στεφάνες στην κάτω γνάθο και άμεση φόρτιση (σύστημα Αnkylos, Friadent)

EEπιβίωση εμφυτευμάτων σε επένθετες πιβίωση εμφυτευμάτων σε επένθετες οδοντοστοιχίες κάτω γνάθουοδοντοστοιχίες κάτω γνάθου

- Επιβίωση εμφυτευμάτων σε αποκαταστάσεις με δοκό στην κάτω γνάθο (παρακολούθηση έως 10 χρόνια)

>90% γιά εμφυτεύματα ΙΜΖ και TPS

Spiekermann et al ,JOMI 1995;10: 231-243

- Επιβίωση εμφυτευμάτων σε αποκαταστάσεις με δοκό στην κάτω γνάθο (παρακολούθηση έως 20 χρόνια)

>90% γιά εμφυτεύματα TPS και ΗαΤi

Ledermann P ,SwissDent 1996;17: 5-18

Επιβίωση εμφυτευμάτων σε αποκαταστάσεις με δοκό στην κάτω γνάθο (παρακολούθηση έως 7 χρόνια)

>90% γιά εμφυτεύματα ΙΤΙ

Κiener et al ,Int J Prosthod 2001;14: 133-140

Υποκειμενική ικανοποίηση Υποκειμενική ικανοποίηση ασθενών από εμφυτευματικές ασθενών από εμφυτευματικές

επένθετες οδοντοστοιχίεςεπένθετες οδοντοστοιχίες

- Θετική στο 85-90% ασθενών σε περίοδο 2 ετών

Smedberg et al, Clin Oral Impl Res 1993:4:39-46

- Θετική στην μεγαλύτερη πλειοψηφία των ασθενών σε διάστημα 5 ετών

Gisani S, Master of Science, Univ. of Leuven 1997

A new treatment concept for immediate loading of implants inserted in the edentulous mandible Eccellente et al (Quintessence Int

2010;41:489–495)

• QUINTESSENCE INTERNATIONAL

• The aim of the present study was to clinically evaluate patients with a mandibular overdenture supported by the Ankylos SynCone system (Dentsply). Method and Materials: 39patients were treated with 156 implants. The treatment method was based on immediate loading of four interforaminal implants without the use of a bar retainer. The denture was retained by prefabricated conical crowns. Results: The cumulative implant survival rate was 98.7% (two failures), while the prosthesis survival rate was 100%. After a total observation of 30.3 months (range 12 to 60 months), all other implants presented healthy peri-implant soft tissue conditions showing low value of clinical parameters. Conclusion: This method facilitates secondary splinting of the inserted complete denture. The conical crowns concept presented here resulted in stable complete denture retention, reduced the denture base, and improved oral hygiene.

The Effectiveness of Immediate, Early, and Conventional Loading of Dental Implants:

A Cochrane Systematic Review of Randomized Controlled Clinical Trials

Esposito, et al JOMI, 2007;22:893–904 • Purpose: To test whether there is a difference in success rates between immediately,

early, and conventionally loaded implants. Materials and Methods: All randomized controlled clinical trials (RCTs) of root-form osseointegrated oral implants having a follow-up of 6 months to 1 year comparing the same osseointegrated root-form oral implants loaded immediately (within 1 week); early (between 1 week to 2 months); or conventionally (after 2 months) were eligible. An exhaustive search was conducted with no language restriction on January 15, 2007. Outcome measures were prosthesis failures, implant failures, and marginal bone levels measured on intraoral radiographs. The statistical unit of the analysis was the patient. Results: Twenty RCTs were identified, and 11 trials including a total of 300 patients were included. Six trials compared immediate versus conventional loading, 3 early versus conventional loading, and 2 immediate versus early loading. None of the meta-analyses revealed any statistically significant differences. Conclusions: It is possible to successfully load dental implants immediately or early after their placement in selected patients, although not all clinicians may achieve optimal results. A high degree of primary implant stability (high value of insertion torque) seems to be 1 of the prerequisites for a successful immediate/early loading procedure. More well-designed RCTs are needed. Priority should be given to trials comparing immediately versus early loaded implants.

Loading Protocols for Mandibular Implant Overdentures: A Systematic Review with Meta-Analysis

Alsabeeha et al 2009

• Purpose: A systematic review and meta-analysis of the current published literature on comparative studies using conventional versus either early and/or immediate loading protocols for mandibular implant overdentures.

• Materials and Methods: A literature search of PubMed (1969–October 2008), EMBASE (1998–October 2008) was conducted. In addition, hand searching through refereed dental journals was also performed for the years 2000 to 2008. Results: A total of 191 studies were identified through the electronic search. After full-text screening and cross-matching with the predefined inclusion criteria, only 10 studies with a minimum follow-up of 2 years were eligible for inclusion in this review. Of the 10 included studies, seven have compared the outcome of conventional versus early loading of implants supporting mandibular overdentures. The remaining three studies, on the other hand, compared the outcome of conventional versus immediate loading. The meta-analysis revealed no significant difference in the outcome between conventional and either early (p = .72) or immediate (p = .08) loading of implants supporting mandibular implant overdentures. Conclusions: Short-term outcomes of early or immediate loading protocols for mandibular implant overdentures achieved comparable success to conventional loading ones. No evidence was found of long-term studies to support or refute either early or immediate loading protocols for mandibular implant overdentures.

Effect of loading time on the success of complete mandibular titanium implant retained overdentures: a systematic review

Kawai et al 2007

• Objectives: The aim of this review was to compare conventional against early/immediate loading protocols of implant-retained overdentures (IOD) in the edentulous mandible. Material and Methods: Medline search via Ovid to extract prospective comparative studies on trials comparing the effect of timing of loading initiation on the success of mandibular IOD. Results: Of 239 articles, only nine trials fulfilled the criteria and involved 30 immediate, 71 early, 77 one-stage conventional, and 66 two-stage conventional subjects. Three immediate loading trials showed an increase in the amount of marginal bone loss over time, while the majority of early and conventionally loaded implants exhibited a decrease in the amount of bone loss in the second year compared with the first 12-month period. Probing depth at 24 months showed a significant difference between early and conventional loading.No other statistically significant differences were found between either immediate or early and conventional loading for any indices.

• Conclusions: No deleterious effects up to 24 months have been shown from immediate or early loading. Conventional loading after a 3-month healing period has not been proven to be the only acceptable protocol for mandibular IOD, but further long-term studies are needed to confirm this.

Consensus Statements and Recommended ClinicalProcedures Regarding Loading Protocols Weber HP et al Proceedings of the Fourth

ITI Consensus Conference, 2008 Germany.• Esthetic zone : Immediate loading of microroughened

dental implants can be considered a viable treatment option for partially edentulous sites in the esthetic zone.

• Treatment within this time frame, however, is complex and can be considered a valid treatment option for clinicians with the appropriate education, experience,and skill.

• Conventional loading (greater than 2 months subsequentto implant placement) remains the procedure of choice for

partially edentulous sites in the esthetic zone

Consensus Statements and Recommended ClinicalProcedures Regarding Loading Protocols Weber HP et al Proceedings of the Fourth

ITI Consensus Conference, 2008 Germany.• For the edentulous mandible, the literature

supports immediate loading of microroughened implants with fixed prostheses or overdentures.

• This consensus statement is made with the understanding that the treatment is complex.

• Treatment within this time frame, for the above indications, can be considered a valid treatment

option for clinicians with the appropriate education,experience, and skill.

Consensus Statements and Recommended ClinicalProcedures Regarding Loading Protocols Weber HP et al Proceedings of the Fourth

ITI Consensus Conference, 2008 Germany.• For the edentulous maxilla, the literature

supports immediate loading of microroughened implants with fixed prostheses. This consensus statement is made with the understanding that the treatment is complex and can be considered a valid treatment option for clinicians with the appropriate education, experience, and skill.

• Insufficient data exist to support immediate loading of dental implants with overdenture prostheses in the edentulous maxilla.

Loading Protocols for Dental Implants in Edentulous PatientsGallucci et al, JOMI 2009;24(SUPPL):132–146

Purpose: The objective of this systematic review was to present the current scientific and clinical evidence related to implant-supported rehabilitations for the edentulous mandible and maxilla.

Materials and Methods: An electronic search covered the period from 1966 to 2008. From a total of 2,371 publications identified from this search, 61 articles fulfilled the inclusion criteria set forth by the authors. It should be noted that only studies reporting on implants with rough surfaces were included in the final selection for this review.

Loading Protocols for Dental Implants in Edentulous PatientsGallucci et al, JOMI 2009;24(SUPPL):132–146

Results: Selected studies yielded data from 2,278 patients and 9,701 implants. Clinical recommendations for implant loading in different edentulous indications were established using a special validation protocol of the published scientific and clinical evidence for different treatment modalities, which was based on the study design, sample size, and outcome homogeneity between studies.

Loading Protocols for Dental Implants in Edentulous PatientsGallucci et al, JOMI 2009;24(SUPPL):132–146

Conclusions: The highest level of scientific and clinical validation was found for conventional loading with mandibular overdentures and maxillary fixed dental prostheses. Insufficient scientific or clinical documentation/validation was found for immediate loading of maxillary overdentures, as well as for immediate loading of immediately placed implants combined with fixed or removable dental prostheses in either jaw. All other loading protocols for edentulous arches showed different degrees of clinical documentation.