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

Identifieur interne : 000340 ( France/Analysis ); précédent : 000339; suivant : 000341

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

Auteurs : Serge Szmukler-Moncler [France] ; Adriano Piattelli [Italie] ; Gian Antonio Favero [Italie] ; Jean-Hermann Dubruille [France]

Source :

RBID : ISTEX:FD1CAC1470E0300C52883B3DDFA0218B228A4D28

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English descriptors

Abstract

In oral implantology, a 3–6 month stress‐free healing period is presently accepted as a prerequisite to achieve bone apposition without interposition of a fibrous scar tissue. This protocol was introduced by Brånemark and co‐workers in 1977. The aim of the present paper is to review the reasons that led Brånemark and collaborators to require long delayed loading periods. It is shown that the requirement for long delayed loading periods was drawn from the initiation and development periods of their original clinical trial. Demanding conditions were met involving simultaneously: 1) patients with poor bone quality and quantity, 2) non‐optimized implant design, 3) short implants, 4) non‐optimized surgical placement, 5) non‐optimized surgical protocol and 6) biomechanically non‐optimized prosthesis. Extrapolation of the requirement for long healing periods from these particular conditions to more standard situations involving refined surgical protocols and careful patient selection might be questioned. Albeit premature loading has been interpreted as inducing fibrous tissue interposition, immediate loading per se is not responsible for fibrous encapsulation. It is the excess of micromotion during the healing phase that interferes with bone repair. A threshold of tolerated micromotion exists, that is somewhere between 50 μm and 150 μm. It is suggested that loading protocols might be shortened through 2 different approaches. The first way would be to decrease stepwise the delayed loading period for free‐standing implants below the presently accepted 3–6 months of healing. The second way would be to identify immediate loading protocols that are capable of keeping the amount of micromotion beneath the threshold of deleterious micromotion. Immediate loading protocols for implants‐retained overdentures and fixed bridges are reviewed. It is shown that successful premature loading protocols require a careful and strict patient selection aimed to achieve the best primary stability. These various protocols need to be further documented in order to assess their predictability.

Url:
DOI: 10.1034/j.1600-0501.2000.011001012.x


Affiliations:


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ISTEX:FD1CAC1470E0300C52883B3DDFA0218B228A4D28

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<name sortKey="Favero, Gian Antonio" sort="Favero, Gian Antonio" uniqKey="Favero G" first="Gian Antonio" last="Favero">Gian Antonio Favero</name>
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<term>Albrektsson</term>
<term>Anchorage</term>
<term>Anterior mand</term>
<term>Anterior part</term>
<term>Apposition</term>
<term>Balshi</term>
<term>Beagle dogs</term>
<term>Bicortical anchorage</term>
<term>Bilat</term>
<term>Bilateral bridge</term>
<term>Biomedical materials research</term>
<term>Bone apposition</term>
<term>Bone ingrowth</term>
<term>Bone quality</term>
<term>Bone type</term>
<term>Bridge bilat</term>
<term>Brous</term>
<term>Carga</term>
<term>Chiapasco</term>
<term>Clinical dentistry</term>
<term>Clinical immobility</term>
<term>Clinical trials</term>
<term>Continuous adjustments</term>
<term>Deleterious micromotion</term>
<term>Dental implantology</term>
<term>Dental implants</term>
<term>Dentistry</term>
<term>Early load</term>
<term>Early loading</term>
<term>Edentulous</term>
<term>Edentulous mandible</term>
<term>Edentulous mandibles</term>
<term>Edentulous patients</term>
<term>Healing</term>
<term>Healing period</term>
<term>Healing periods</term>
<term>Healing phase</term>
<term>Healing time</term>
<term>Henry rosenberg</term>
<term>Histological</term>
<term>Histomorphometric study</term>
<term>Immediate loading</term>
<term>Immediate loading protocols</term>
<term>Implant</term>
<term>Implant dentistry</term>
<term>Implant design</term>
<term>Implant integration</term>
<term>Implant length</term>
<term>Implant prognosis</term>
<term>Implant therapy</term>
<term>Implantology</term>
<term>Implants research</term>
<term>International journal</term>
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<term>Mandible</term>
<term>Maxilla</term>
<term>Maxillofacial</term>
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<term>Piattelli</term>
<term>Pilliar</term>
<term>Pilot study</term>
<term>Premature loading</term>
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<term>Prosthetic dentistry</term>
<term>Protocol</term>
<term>Provisional restoration</term>
<term>Quintessence publishing company</term>
<term>Restorative dentistry</term>
<term>Routine period</term>
<term>Salama</term>
<term>Schnitman</term>
<term>Schroeder</term>
<term>Schweizerische monatschrift</term>
<term>Screw implants</term>
<term>Splinted</term>
<term>Straumann institute</term>
<term>Success rate</term>
<term>Surgical</term>
<term>Surgical placement</term>
<term>Surgical protocol</term>
<term>Survival rate</term>
<term>Tarnow</term>
<term>Therapeutic procedures</term>
<term>Titanium</term>
<term>Titanium implants</term>
<term>Years years</term>
<term>Zarb</term>
<term>Zarb jansson</term>
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<term>Adell</term>
<term>Albrektsson</term>
<term>Anchorage</term>
<term>Anterior mand</term>
<term>Anterior part</term>
<term>Apposition</term>
<term>Balshi</term>
<term>Beagle dogs</term>
<term>Bicortical anchorage</term>
<term>Bilat</term>
<term>Bilateral bridge</term>
<term>Biomedical materials research</term>
<term>Bone apposition</term>
<term>Bone ingrowth</term>
<term>Bone quality</term>
<term>Bone type</term>
<term>Bridge bilat</term>
<term>Brous</term>
<term>Carga</term>
<term>Chiapasco</term>
<term>Clinical dentistry</term>
<term>Clinical immobility</term>
<term>Clinical trials</term>
<term>Continuous adjustments</term>
<term>Deleterious micromotion</term>
<term>Dental implantology</term>
<term>Dental implants</term>
<term>Dentistry</term>
<term>Early load</term>
<term>Early loading</term>
<term>Edentulous</term>
<term>Edentulous mandible</term>
<term>Edentulous mandibles</term>
<term>Edentulous patients</term>
<term>Healing</term>
<term>Healing period</term>
<term>Healing periods</term>
<term>Healing phase</term>
<term>Healing time</term>
<term>Henry rosenberg</term>
<term>Histological</term>
<term>Histomorphometric study</term>
<term>Immediate loading</term>
<term>Immediate loading protocols</term>
<term>Implant</term>
<term>Implant dentistry</term>
<term>Implant design</term>
<term>Implant integration</term>
<term>Implant length</term>
<term>Implant prognosis</term>
<term>Implant therapy</term>
<term>Implantology</term>
<term>Implants research</term>
<term>International journal</term>
<term>Ledermann</term>
<term>Lekholm</term>
<term>Loading</term>
<term>Loading period</term>
<term>Loading periods</term>
<term>Loading protocols</term>
<term>Mand</term>
<term>Mandible</term>
<term>Maxilla</term>
<term>Maxillofacial</term>
<term>Maxillofacial implants</term>
<term>Maxillofacial surgery</term>
<term>Micromotion</term>
<term>Oral implantology</term>
<term>Osseointegrated</term>
<term>Osseointegrated implants</term>
<term>Osseointegration</term>
<term>Overdenture</term>
<term>Overdentures</term>
<term>Patient selection</term>
<term>Periodontology</term>
<term>Piattelli</term>
<term>Pilliar</term>
<term>Pilot study</term>
<term>Premature loading</term>
<term>Prosthesis</term>
<term>Prosthetic</term>
<term>Prosthetic dentistry</term>
<term>Protocol</term>
<term>Provisional restoration</term>
<term>Quintessence publishing company</term>
<term>Restorative dentistry</term>
<term>Routine period</term>
<term>Salama</term>
<term>Schnitman</term>
<term>Schroeder</term>
<term>Schweizerische monatschrift</term>
<term>Screw implants</term>
<term>Splinted</term>
<term>Straumann institute</term>
<term>Success rate</term>
<term>Surgical</term>
<term>Surgical placement</term>
<term>Surgical protocol</term>
<term>Survival rate</term>
<term>Tarnow</term>
<term>Therapeutic procedures</term>
<term>Titanium</term>
<term>Titanium implants</term>
<term>Years years</term>
<term>Zarb</term>
<term>Zarb jansson</term>
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<div type="abstract" xml:lang="en">In oral implantology, a 3–6 month stress‐free healing period is presently accepted as a prerequisite to achieve bone apposition without interposition of a fibrous scar tissue. This protocol was introduced by Brånemark and co‐workers in 1977. The aim of the present paper is to review the reasons that led Brånemark and collaborators to require long delayed loading periods. It is shown that the requirement for long delayed loading periods was drawn from the initiation and development periods of their original clinical trial. Demanding conditions were met involving simultaneously: 1) patients with poor bone quality and quantity, 2) non‐optimized implant design, 3) short implants, 4) non‐optimized surgical placement, 5) non‐optimized surgical protocol and 6) biomechanically non‐optimized prosthesis. Extrapolation of the requirement for long healing periods from these particular conditions to more standard situations involving refined surgical protocols and careful patient selection might be questioned. Albeit premature loading has been interpreted as inducing fibrous tissue interposition, immediate loading per se is not responsible for fibrous encapsulation. It is the excess of micromotion during the healing phase that interferes with bone repair. A threshold of tolerated micromotion exists, that is somewhere between 50 μm and 150 μm. It is suggested that loading protocols might be shortened through 2 different approaches. The first way would be to decrease stepwise the delayed loading period for free‐standing implants below the presently accepted 3–6 months of healing. The second way would be to identify immediate loading protocols that are capable of keeping the amount of micromotion beneath the threshold of deleterious micromotion. Immediate loading protocols for implants‐retained overdentures and fixed bridges are reviewed. It is shown that successful premature loading protocols require a careful and strict patient selection aimed to achieve the best primary stability. These various protocols need to be further documented in order to assess their predictability.</div>
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