Tettamanti L, Andrisani C, Bassi M Andreasi, Vinci R, Silvestre-Rangil J, Tagliabue A
Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Private Practice in Matera, Matera, Italy.
Oral Implantol (Rome). 2017 Sep 27;10(2):129-139. doi: 10.11138/orl/2017.10.2.129. eCollection 2017 Apr-Jun.
Modern dentistry have witnessed, a rapid and continuing evolution. Concerning the implant-rehabilitation protocols, they have been redefined in order to satisfy patient's increasing expectations in terms of comfort, aesthetic and shorter treatment period. The purpose of this review is to explore the concept of implant immediate loading and the indications for clinical practice. All the critical aspects that could influence the outcomes of this treatment will also be considered.
Three protocols for implant load timing have been classified: immediate loading implants (ILI); early loading implants (ELI); and conventional loading implants (CLI). Two subclassifications point out the different loading modality: 1) Occlusal loading or Non-Occlusal loading, 2) Direct loading or Progressive loading. Micromovements have been considered, since the start of implant dentistry, one of the main risk for the success of osseointegration. The determinant and most accessible parameter to assess the primary stability is the implant insertion torque value. To achieve the necessary torque value to perform immediate loading, it is therefore important to evaluate the bone density at the implant site. Computerized tomography (CT) has been regarded as the best radiographic method to evaluate the residual bone.
The clinical success of this technique is highly dependent on many factors: patient selection, bone quality and quantity, implant number and design, implant primary stability, occlusal loading and clinician's surgical ability. Among these, implant primary stability is undoubtedly the most important.
Studies on ILI show that successful outcome can be expected, if the previous criteria are fulfilled. It seems that ILI demonstrate a greater risk for implant failure when compared to CLI, although the survival rates were high for both the procedures. The use of different surgical procedures, type of prostheses, loading times and have very different study designs. This lack of homogeneity limits the relevance of the conclusions that can be drawn.
现代牙科领域经历了快速且持续的发展。关于种植修复方案，为满足患者在舒适度、美观度及缩短治疗周期方面日益增长的期望，这些方案已被重新定义。本综述的目的是探讨种植即刻负重的概念及临床应用指征。同时也会考虑所有可能影响该治疗效果的关键因素。
种植体负重时机的三种方案已被分类：即刻负重种植体（ILI）；早期负重种植体（ELI）；以及传统负重种植体（CLI）。两种亚分类指出了不同的负重方式：1）咬合负重或非咬合负重，2）直接负重或渐进性负重。自种植牙科开始以来，微动就被视为骨结合成功的主要风险之一。评估初期稳定性的决定性且最易获取的参数是种植体植入扭矩值。因此，为达到进行即刻负重所需的扭矩值，评估种植部位的骨密度很重要。计算机断层扫描（CT）被认为是评估剩余骨的最佳影像学方法。
该技术的临床成功高度依赖于许多因素：患者选择、骨质量和骨量、种植体数量和设计、种植体初期稳定性、咬合负重及临床医生的手术能力。其中，种植体初期稳定性无疑是最重要的。
关于即刻负重种植体的研究表明，如果满足先前的标准，有望获得成功的结果。与传统负重种植体相比，即刻负重种植体似乎显示出更高的种植失败风险，尽管两种手术的生存率都很高。不同的手术方法、假体类型、负重时间以及研究设计差异很大。这种缺乏同质性限制了所能得出结论的相关性。
