Ganeles Jeffrey, Wismeijer Daniel
Florida Institute for Periodontics and Dental Implants, Boca Raton, FL 33431, USA.
Int J Oral Maxillofac Implants. 2004;19 Suppl:92-102.
The objective of this consensus committee report was to review the available literature published predominantly in refereed journals to summarize findings, data, and conclusions as they related to reduced healing times and protocols for single-tooth and partial-arch clinical situations. Early loading of dental implants has been defined as restoration of implants in or out of occlusion at least 48 hours after implant placement, but at a shorter time interval than conventional healing. Immediate loading or restoration has been defined as attachment of a restoration in or out of direct occlusal function within 48 hours of surgical placement.
Six articles addressing early loading, with a mixture of single-tooth and partial-arch clinical conditions and including some controlled cohort studies, were reviewed. Immediate loading or restoration of dental implants in single-tooth and partial-arch applications, was extensively reviewed. An attempt was made to isolate and categorize similar case types to discern trends and relevant factors. Variables that were considered included single- or multiple-tooth conditions, immediate or delayed placement in extraction sockets, effect of implant surface and geometry, bone quality, implant stability, surgical technique, occlusal design, effect of cigarette smoking, and stability of results.
Combined data from 6 early loading studies on single-tooth and partial-arch applications revealed 1,046 implants with a survival rate of 98.2%. Long-term data for most of the early loading studies were not yet available. Most of the publications on immediate loading or restoration of dental implants were written as case series rather than scientific studies.
In general, most publications indicated that with attention to appropriate factors, implant survival with immediate restoration was comparable to the results with conventional and early loading protocols. It should be recognized that, with few exceptions, these conclusions may be misleading statistical phenomena of the authors, as most publications were written by exceptionally experienced, highly skilled practitioners working under tightly controlled clinical conditions on a relatively small, statistically inconclusive number of implants and patients.
本共识委员会报告的目的是回顾主要发表在同行评审期刊上的现有文献，总结与单颗牙和局部牙弓临床情况的愈合时间缩短及方案相关的研究结果、数据和结论。牙种植体的早期负载被定义为在种植体植入后至少48小时进行种植体修复，无论是否咬合，但时间间隔短于传统愈合时间。即刻负载或修复被定义为在手术植入后48小时内连接直接具有或不具有直接咬合功能的修复体。
回顾了6篇涉及早期负载的文章，这些文章涵盖单颗牙和局部牙弓临床情况，包括一些对照队列研究。对单颗牙和局部牙弓应用中牙种植体的即刻负载或修复进行了广泛回顾。试图分离并分类相似的病例类型，以辨别趋势和相关因素。考虑的变量包括单颗牙或多颗牙情况、在拔牙窝中的即刻或延迟植入、种植体表面和几何形状的影响、骨质量、种植体稳定性、手术技术、咬合设计、吸烟的影响以及结果的稳定性。
6项关于单颗牙和局部牙弓应用的早期负载研究的综合数据显示，共有1046颗种植体，存活率为98.2%。大多数早期负载研究的长期数据尚未可得。大多数关于牙种植体即刻负载或修复的出版物是病例系列报告，而非科学研究。
总体而言，大多数出版物表明，在关注适当因素的情况下，即刻修复的种植体存活率与传统和早期负载方案的结果相当。应该认识到，除少数例外，这些结论可能是作者误导性的统计现象，因为大多数出版物是由经验极其丰富、技术高超的从业者撰写的，他们在严格控制的临床条件下，针对数量相对较少、统计学上无定论的种植体和患者开展工作。
