|Year : 2011 | Volume
| Issue : 1 | Page : 18-21
Immediate loading in post-extraction implantation: A retrospective study
Douillard Yves1, JF Borel2, JF Keller3, L Antoine3, Emmanuel Nicolas4
1 Univ Clermont1, UFR d'Odontologie, Clermont-Ferrand;CHU Clermont-Ferrand, Service d'Odontologie, Hôtel-Dieu, Clermont-Ferrand;Implantology Private Clinic, "Actis Dentaire", Clermont-Ferrand, France
2 Implantology Private Clinic, "Actis Dentaire", Clermont-Ferrand, France
3 Univ Clermont1, UFR d'Odontologie, Clermont-Ferrand;CHU Clermont-Ferrand, Service d'Odontologie, Hôtel-Dieu, Clermont-Ferrand, France
4 Univ Clermont1, UFR d'Odontologie, Clermont-Ferrand;CHU Clermont-Ferrand, Service d'Odontologie, Hôtel-Dieu, Clermont-Ferrand;Univ Clermont1, EA 3847, UFR d'Odontologie, Clermont-Ferrand, France
|Date of Web Publication||2-Feb-2011|
Faculté de Chirurgie Dentaire, 11 Boulevard Charles de Gaulle, 63000 Clermont-Ferrand
| Abstract|| |
Background: The evolution in implant procedures has helped decrease loading times. Procedures can be optimized in post-extraction implantation with immediate loading. With a decrease in periodical needs for oral rehabilitation, the biological impact and psychological integration may be improved. This study aims to compare immediate versus delayed loading in post-extraction implantation.
Materials and Methods: In a private practice of two practitioners, 170 Straumann post-extraction implants (107 immediate and 63 delayed loading) were tracked during a 7-year period.
Results: According to Misch criteria, no difference in success rates was found between immediate (96.4%) and delayed (96.8%) loading in post-extraction implants.
Conclusion: This retrospective study showed that a post-extraction procedure does not compromise immediate loading success in the short and medium term. Complementary prospective and randomized studies are necessary to validate these results.
Keywords: Delayed loading, implants, immediate loading, post extraction
|How to cite this article:|
Yves D, Borel J F, Keller J F, Antoine L, Nicolas E. Immediate loading in post-extraction implantation: A retrospective study. J Dent Implant 2011;1:18-21
|How to cite this URL:|
Yves D, Borel J F, Keller J F, Antoine L, Nicolas E. Immediate loading in post-extraction implantation: A retrospective study. J Dent Implant [serial online] 2011 [cited 2013 May 24];1:18-21. Available from: http://www.jdionline.org/text.asp?2011/1/1/18/76427
| Introduction|| |
Current trends in implantology aim to reduce loading delay but not necessarily with osseo-integration. Procedures may be optimized in post-extraction implantation with immediate loading.  Consequently, a transitional denture is not required and esthetics is improved. The psycho-social aspect improves and healing time is reduced, and thus, the neuro-physiological integration of the prostheses is facilitated.
Current literature reports similar success ratios when comparing immediate and delayed loading, ,, but it only concerns rehabilitation of complete edentulous subjects. ,,, With this procedure, no post-extraction implantation study has been referenced. Immediate loading in post-extraction implantation also presents some disadvantages due to extreme anatomical and clinical variability. Consequently, this type of procedure requires an experienced practitioner. The lack of data may be explained by the lack of reproducibility of this procedure and the increased number of implants necessary as compared to the conventional procedures.  Literature analysis reveals that the observation period of the studies was a maximum of 60 months. This relatively short period may not allow for validity, as the result criteria were implant durability and absence of complications. The implant's bio-physiological state and surrounding tissue were rarely considered. An interesting alternative to this evaluation methodology uses the Misch criteria.  Implant success is determined not only by its duration but also according to the evaluation of the surrounding periodontal tissue. This recent retrospective study, designed using these criteria, proposes evaluating post-extraction implant health with immediate or delayed loading.
| Materials and Methods|| |
This retrospective implant follow-up study was set in the context of two private practitioners. The group of subjects was in rehabilitation with a post-extraction implant over a period of at least 7 years (164 patients, 1997-2004). They had been seen in consultation over the course of 2006 for implant follow-up. The collected observations were analyzed retrospectively and anonymously by an independent observer. Based on this period and these criteria, 81 rehabilitated subjects with Straumann implants (Straumann, Waldenburg, Switzerland) were evaluated by clinical and radiological examinations. After in-depth questioning, the observations were informed to the selected patients, who all gave their consent.
The evaluation criteria are shown in [Table 1]. The observations for each implant were made by the same observer according to the Albrektsson criteria, , modified by Misch.  Periodontal pocket depth and a bleeding indicator were used. This was a single-blind evaluation as the observer was not aware of which implant loading procedure had been used.
Composition of the studied groups
Further to the evaluation, two groups of subjects were established retrospectively according to the loading procedure [Figure 1].
Group A (46 subjects) included 63 delayed loading implants (after osseo-integration, for more than 2 months) and Group B (38 subjects) included 107 immediate loading implants (0-7 days). Three subjects were included in the two groups because of the presence of both immediate and delayed implants.
All analyses were performed with SPSS® 11.5. The homogeneity of demographics and oral habits between the two groups was evaluated with the Pearson chi-square test. The success rate of the two procedures was also evaluated using the same test. The mean biological criteria (bony volume and periodontal health) were compared using the student's t-test (a = 0.05).
| Results|| |
Description of the studied sample
The subjects' mean age was 57.8 years (±10) in Group A and 58.5 years (±11) in Group B [Table 2]. It was observed that the two groups were homogenous according to gender, general health criteria, tobacco use and oral hygiene (Chi-square test, nonsignificant). As these parameters are recognized to be indicators of failure or success in implantology; the two groups were considered to be methodologically comparable.
|Table 2 :Implant distribution according to selected evaluation criteria and the group |
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Descriptions of the sitting implants
In the two groups, the health status of the persons subjected to the 170 implants was estimated. Sixty-three were loaded after a period of osseo-integration (Group A: 38 maxillary implants and 25 mandibular implants) and 107 were loaded immediately (Group B: 85 in maxilla and 22 in mandible) [Table 2]. [Table 3] indicates the implant distribution in groups A and B according to the Misch qualitative evaluation scale. Success rate were 96.8% in Group A and 96.4% in Group B (Pearson chi square, nonsignificant). Two implants in Group A failed, one in the maxilla after 8 months loading and one in the mandible 1 month after implantation without loading. These were later successfully replaced. In Group A, three maxillary implants failed after 1-4 months of loading. They were immediately replaced and loading was delayed. The three implants are now osseo-integrated.
|Table 3 :Implant distribution between the two groups according to Misch scale and type of prosthesis |
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In Group A, one implant required guided bony regeneration and two implants were connected by a connective tissue graft. The three implants were then suitably integrated. In Group B, one implant required a bone graft and three required a connective tissue graft. Among them, only one implant was in the Misch group III (poor quality of integration).
At the time of evaluation, in Group A, the time elapsed was an average of 35.4 months (6 months-8 years). Among these, 28 implants had been in place over 3 years, with a success rate of 100% (26 in the Misch group I and 2 in the Misch group II). As post-extraction immediate loading is a more recent procedure, the post-implantation period in Group B was 18.5 months (6 months-4 years), but with 17 loaded implants over 3 years; 100% were categorized in the Misch group I.In Group A, loading occurred on average 4 months after implantation and the definitive prosthesis set within 2 months. In Group B, most temporary loading occurred on the same day as implantation or, at the latest, after 7 days. The definitive prosthesis was set, at the latest, after 6 months.
In Group A, the implants were supported by fixed single prostheses (63 implants, 2 with temporary prostheses) and bridges (31 implants). In Group B, 13 implants had single crowns, 49 had bridges (with 8 still with temporary prostheses) and 45 had metal structures (10 were still temporary). [Table 2] shows the implant distribution according to prostheses type reconstruction and implantation quality scale.
In Group A, the mean measurements for periodontal probing were 1.4 mm (1-4 mm) and 1.5 mm (1-3 mm), whereas in Group B, the difference between the two groups was statistically nonsignificant ("t" test, nonsignificant). Mean proximal bone loss in the two groups was not significantly different. Similarly, the mean vestibular recession comparison in the two groups was nonsignificant: 0.35 mm (0-2 mm) in Group A and 0.30 mm (0-4 mm) in Group B.
| Discussion|| |
This retrospective study demonstrates similar success rates in both immediate (96.4%) and delayed (96.8%) loading of post-extraction implants. These results are in line with post-extraction results observed by Jaffin  (93% success, 236 Straumann implants). They also confirm the Chiapasco and Gatti  study for immediate loading (97.6%, 328 different types of implants). Our findings are in line with literature data , and show that post-extraction implantation does not compromise the issue of immediate loading. However, the retrospective nature of this study limits its scientific interest, but can be used as a basis for future prospective trials.
Implant failures were mostly seen in single restorations (3/5 failures). In immediate loading of single implants, the prostheses rehabilitation period, primary and occlusal stability and the functional aspect must be carefully considered. ,, A literature analysis showed that many authors confounded "immediate loading" and "immediate esthetic finish".  In our study, in post-extraction implantation, there were no clinical differences in peri-implantitis as far as immediate and delayed loading were concerned. However, it is important to underline that these results are the only one of their kind that are validated and are specifically applicable to a particular implant system. These criteria must be considered according to the implant system used. For example, immediate loading in post-extraction helps improve the quality of life. However, to date, no study has quantitatively evaluated this improvement. Also, this procedure should not be abused.
To our knowledge, few protocols specifically validated for this implant-prostheses procedure currently exist.  Consequently, this retrospective study is an important basis for validating post-extraction immediate loading.
| Conclusion|| |
This retrospective study on the follow-up of 170 implants showed that the post-extraction procedure does not compromise immediate loading success in the short and medium term. Complementary prospective and randomized studies are necessary to validate these results. A longer-term follow-up would help integrate this procedure in implantology.
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[Table 1], [Table 2], [Table 3]