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10 I I research _ dental implant loading implants3_2010 implants, placed into edentulous arches using an im- mediateloadingprotocol.Datawerecollectedfor344 single-stage implants placed into 56 edentulous arches (39 maxillae and 17 mandibles ) of 43 patients and immediate loaded with a one piece provisional fixed prosthesis. Each patient received between 4 and 18 implants in one or both dental arches. Periapical radiographs were obtained over a 2 to 10 year follow up period to evaluate crestal bone loss following insertion of the definitive metal-ceramic fixed prostheses. A total of 16implantsfailedtosuccessfullyintegrate.Increased ratesoffailurewereassociatedwithreducedimplant length, placement in the posterior region of the jaw, increased implant diameter and surface treatment. Implant length emerged as the sole significant pre- dictor of implant failure. In this prospective analysis, in 56 consecutively treated edentulous arches with multiple single stage dentalimplantsloadedimmediately,reducedimplant length was the sole significant predictor of failure.9 George Romanos, Georg Hubertus Nentwig evalu- ated immediate loading of oral implants on heavy smokers. Nine patients (5 male and 4 female) with a mean age of 52.4 ± 8.3 years who smoked more than 2 packs a day for more than 10 years (heavy smokers) were included in this prospective clinical study. Sev- enty two implants, 6 implants in each jaw, 6 maxillae and 6 mandibles, made from comercially pure tita- nium (grade 2), with a progressive thread design and sandblasted surface (Ankylos, Friadent) were used. Provisionalfixedprostheseshadcentricocclusalcon- tactsandgroupfunctioninthelateralmovementsof the mandible (immediate occlusal loading). Clinical and radiographic indices were evaluated at the start of loading and at 3 month intervals after loading. After a mean loading period of 33.7 ± 19.0 months (range 6 to 66 months) one implant was mobile. All clinical indices had values in normal ranges. The Peri- otestvaluesdecreasedwithtime,indicatedincreased security of implants in bone. Crestal bone loss was stable,withonlytwositespresentedminimalvertical bone loss and six presented minimal horizontal bone loss.Thisstudyshowedthatimmediateloadingoforal implants may be successful in heavy smokers under some circumstances.10 Gioacchino Cannizzaro, MicheleLeone,UgoConSolo,VittorioFerri,MarcoEs- posito compared the efficacy of immediae function- ally loaded implants placed with a flapless procedure (test group) versus implants placed after flap eleva- tion and conventional load-free healing (control group)inpartiallyedentulouspatients.Fortypatients were randomized: 20 to the flapless immediate loaded group and 20 to the conventional group. Im- plantsintheimmediatelyloadedgroupwereprovided with full acrylic resin temporary restoration in the same day. Implants in the conventional group were submerged (anterior region) or left unsubmerged (posterior region) and left load-free for 3 months (mandibles) or 4 months (maxillae). 52 implants were placed in the in the flapless group and 56 in the con- ventionally group. After three years no dropouts or failures occurred. When comparing baseline data with those at the years 1, 2, and 3 within each group, mean Osstell val- ues of the flapless group did not increase, whereas there were statistically significant increases in the Periotest values. Implants can be successfully placed flapless and loaded immediately without compromising success rates; the procedure decreases treatment time and patient discomfort.11 Roberto Crespi, Paolo Cappare, Enricho Gherlone, George E. Romanos performed a study to report a clinicalcomparativeassessementofcrestalbonelevel change around single implants in fresh extraction sockets in the esthetic zone of the maxilla either im- mediately loaded or loaded after a delay. Forty pa- tients were included in a prospective, randomized study. All patient required 1 tooth extraction. Im- plants were positioned immediately after tooth ex- traction and were loaded immediately in the test group(20implants)andafter3monthsinthecontrol group (20 implants). All implants were 13 mm long. Thirty implantshadadiameterof5mm,and10hada diameterof3.75mm.Radiographicexaminationwas made at baseline, at 6 months and at 24 months. Af- ter a 24-month follow up period, a cumulative sur- vival rate of 100 % was reported for all implants. The success rate and radiographic results of immediate restorations of dental implants placed in fresh ex- traction sockets were comparable to those obtained in delayed loading group.12 Two studies registered a 18 month follow up. Joseph Nissan, George E. Ro- manos,OferMardinger,GavrielChaushuassessedthe clinical effectiveness of immediate nonfunctional loading for single tooth implants placed in the ante- rior maxilla following augmentation with cancellous freeze-dried block graft, with clinical outcomes up to 18 months after placement. Implants were immedi- ately restored with unsplinted acrylic resin provi- sionalcrowns.Elevenpatientsreceived12implantsin theanteriormaxilla,andintraorallyradiographswere obtained immediate after implant placement and at 6, 12 and 18 months. Survival rate and radiographic marginal bone loss were evaluated at 0, 6, 12 and 18 months. Marginal bone loss did not extend beyond the first thread up to a 18 month follow-up. Within the limits of this study, immediate non- functional loading for single-tooth implants placed