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Immediate Loading Implant-Retained Overdenture: A Randomized Controlled Study

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Immediate Loading Implant-Retained Overdenture:  A Randomized Controlled Study.


The  predictability  of  dental  implants  has  changed  the  prosthetic  rehabilitation  of mandibular edentulous patients. The preponderance of recent evidence suggests that the use of  dental  implants  to  retain  mandibular  overdenture  has  significantly  improved  clinical outcomes  and  quality  of  life.1,  2   Moreover,  using  unsplinted  implants  with  a  mandibular overdenture improves patients’ satisfaction, and appears to meet expectations in edentulous patients.3    It  has  been  suggested  that  implant  retained  mandibular  overdenture  may  be considered  the  standard  of  care  treatment  in  mandibular  edentulism  of  which  implant supported fixed prosthesis is not treatment of choice.1-3

Branemark’s initial recommendation called for a healing period of three months prior to

loading    mandibular    implants.4           Thus,    conventional    treatment    with    implant-retained overdentures requires that, the attachments be installed no sooner than three months after implant placement. This delay in loading often presents a significant detriment to a patient’s function quality of life.

It  has  been  suggested  that  implants  with  enhanced  surface  microtopography  can achieve  secondary  stability  at  earlier  healing  times.5   Several  clinical  studies  on  different

implant  systems  showed  that  the  loading  time  for  implant  retained  mandibular  complete overdentures  can  be  safely  shortened  without  compromising  osseointegration  process  and implant success rate.6-10 Delayed or early loading of implant-retained mandibular overdentures

showed  equivalent  success  rate  when  implant  retained  mandibular  complete  overdenture opposed  a  maxillary  complete  denture.6-8   Several  studies  on  immediately  functional  loaded and splinted implant-supported overdenture reported high success rates.11-15

The aim of this study was to clinically and radiographically compare implant stability and crestal bone changes around implant immediately loaded versus delayed loaded implant to retain mandibular overdenture.

Study design:

This study was a single site, randomized, controlled, and prospective clinical study. Twenty completely edentulous patients were enrolled in this study from the clinics of the University of Kentucky, College of Dentistry. This study was received IRB approval.

Each subject was randomly assigned to one of the  treatment groups:                          

Test Group (n=10): The test group were received immediate loaded unsplinted implant retained mandibular complete overdenture (20 implants). 1 patient dropped out of study.

Control Group (n=10): The control group were received delayed loaded unsplinted implant retained mandibular complete overdenture (20 implants).

Treatment protocol:

All participants received new maxillary and mandibular complete dentures prior to implant  placement.  The  two  implants  were  inserted  under  local  anesthesia  following  the routine  administration  of  prophylactic  antibiotic  medications  one  hour  prior  to  the  surgical procedure. A crestal incision was made and full thickness flap was conservatively reflected to reduce the possibility of postsurgical swelling and to allow surgical access to the implant sites. The implant positions were pre-determined with a surgical guide. Two osteotomies at the site of  mandibular  canines  were  prepared according to the  protocols  specified by BioHorizons®. For  both  test  and  control  groups,  implants  were  inserted  and  peak  insertion  torque  was measured immediately. Implant stability quotient (ISQ) measurements were recorded by using resonance   frequency   analysis   (RFA)   using   Osstell   mentor®.   Using   the   manufacturers’ guidelines,  Smartpig  type  4  were  attached  to  the  implant  platform  and  the  mean  of  two consecutive  ISQ  values  were  calculated.  Then  locator  abutments  were  connected  to  the implant  fixture  with  20  Ncm  torque  in  the  test  group  and  cover  screw  were  placed  into implant fixture in the control group. The flap was sutured with “4-0” Vicryl® sutures to achieve tension-free primary closure. The complete denture was modified by creating a space in the intaglio  surface  for  the  metal  housing  of  the  attachment.  The  attachment  were  picked  up intraorally with Quick-Up® autopolymerizing resin. Cone Beam CT scan was made immediately after  implant  placement  for  research  purposes  for  both  groups.  For  the  control  group,  the locator  abutments  delivery  and  intraoral  attachment  pick  up  were  performed  at  3-month following implant placement.


•Implant success rate after one year follow up was %100 in both groups.
•Overall marginal bone level changes was -0.78 mm ± 0.27mm for test group and -1.2 mm ± 0.5 mm for control group. Main marginal bone loss was reported on buccal plate.
•Attached  gingiva changes was -0.4 mm ±  0.3mm for test group and  + 0.2 mm ±  0.1 mm for control group.
•Osstell® value for test group was increased by + 0.18  ISQ  and for control group was increased by +1 ISQ
•Gingival index was higher in control group than test group with 0.5 ± 0.58.
•Plaque index was higher in test group than control group with 0.88 ± 0.35.

No statistically significant difference between groups (p > .05


Recent study by Elsyad et al, found no statistically significant difference in implant stability at 12 months between immediate and delayed loading groups.14  Ma and Payne found no detrimental effect on marginal bone  levels  with  immediate  loading  protocols,15   while  others  found  statistical  significance  in  levels  of increased  vertical  bone  loss  around  immediately  loaded  implants  compared  with  a  delayed  loading protocol.14

This preliminary data supports a suggestion that any difference in crestal bone loss found between groups may be considered to lack clinical significance for outcome measurements. Further long term evaluation of

crestal  bone  height  remains  necessary  as  immediate  loaded  IOD  is  utilized  more  in  clinical  practice. Preliminary data reflecting ISQ values supports previous findings and suggests that immediate loading of implants achieving optimal primary stability yields predictable results at 3 and 12 months. 14


Although,  the  limitations  of  this  study  and  the  small  sample  size,  the  results  are  clinically  relevant  and significant. Immediate loading protocol for unsplinted implant retained mandibular complete overdenture is predictable treatment, safe, and as successful as delayed loading protocol.




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