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I 15 research _ dental implant loading I implants3_2010 weeks after loading. With 1.0-N loading, the uptake ratio did not differ among measurement points (Friedman and Steel tests, P > .05 ). The uptake ratios with the 2.0 and 4.0 loads were significantly higher than those with the 0.5 and 1.0-N loads (Tukey test, P < 0,5).21 _Discussion Successfully osseointegrated dental implants are anchored directly to the bone. However, in the pres- enceofmovement,asofttissueinterfacemayincap- sulate the implant causing its failure.To minimize the risk of soft tissue encapsulation, it has been recom- mended that implants should be kept load-free by submerging them during the healing period.24 Immediatly loaded or early loaded implants after insertiondevelopspecialandspecificclinicalimplica- tions with an impact on the treatment time. If it can shortened to a very large extent it involves a signifi- cantfacttothebenefitofthepatients.Themainpur- pose of these studies is actually the achievement of a successfulfinalprothesis.Implantlossisasignificant risk factor in this respect. This review has been intended for gathering data and information available in reference literature in ordertoachieveaclinicalconclusionastofixedorre- movable implant-supported prostheses based on time of loading. Attempts to use standard systematic reviewprocedures(applicationofscientificstrategies in ways that limit bias to the assembly, critical ap- praisal and synthesis of all relevant studies that ad- dress a specific clinical question) have not been en- tirely possible because of report variability, and this limits the ability to draw conclusive comments from the work. Nowadays, immediate or early dental implants loading with a careful patients’ selection is possible. Theclinician’sexperienceisanobligatoryprerequisite inreachingoptimumresultswithimmediateloading. Oneoftheconditionsorrequirementsinfluencingthe proceduresuccessappearstobethehighprimarysta- bility of the implant at the insertion time. In future, additional and well structured studies are important andnecessarytocompleteaclearprotocolforimme- diate and early loading. No statistic difference for prothesisandimplantssuccessrateormarginalbone loss with different time of implant loading has been observed. All known risk factors and contraindica- tions for osseointegration with a standard protocol will be equally or even more important with immedi- ate or early loading protocols. It is thus implied that successful osseointegration with reduced loading protocols requires critical case selection and meticu- lous surgical and prosthetic management. A surgical technique that minimizes heat genera- tionandpressurenecrosisisofparticularimportance with both early and immediate implant loading. It is also dependent on the quality and quantity of exist- ing bone at the implant site and the ability to achieve andmaintainadequatestabilityoftheimplantsothat micromotion is kept below the biological threshold. The level of skill and experience of the surgeon play a roleintreatmentoutcomes.Thepresenceofinfection in the implant area will affect osseointegration. Un- treated periodontitis and periapical pathology must beaddressedbeforeimplantplacement,independent of the loading protocol. Management of micromotion of the implant is critical for osseointegration and many studies stress the importance of minimizing functional loading in both centric and lateral excursion. Non axial loading isdifficulttomeasureclinicallyandtheidealocclusal scheme has not been outlined. It is therefore impos- sible to state that parafunction is an implicit contra- indicationtoimmediateorearlyloadingbutitisgen- erally considered to be a risk factor. Relatively few data about the relationship be- tween soft tissue and immediate or early loading are available. Marginal recessions around the immedi- ately loaded implant were comparable to those con- ventionally loaded.22, 23 Smoking has been shown to have a negative im- pact on osseointegration 25, 26 and, as such, it must be also considered a potential risk factor for immediate and early loading protocols even though some stud- ies showed that immediate loading of oral implants may be successful in heavy smokers under some cir- cumstances.10, 27, 28 Itisfundamentallynecessaryforatreatmentplan to offer an advantage to the patient. Immediate and early loading benefits reduce surgical steps by elimi- natingthesecondprocedure,shortentreatmenttime and provide a functional and psychologic advantage of prosthetic rehabilitation. Immediate restauration or loading may be partic- ulary attractive to a patient as temporization with a removableapplianceisnotrequiredafterimplantfix- tureplacement.Theadvantagemustbecarefullycon- sideredagainstapotentialincreasedriskoffailurefor immediate or early loading times. An increased success rate was generally stated in thestudies;however,twostudies15,18 haverevealeda relativelyhighfailurerate.Inonestudy15 ,onepatient ofeachgrouplostbothimplants.Thelossoccurredsix monthsafterloadingindelayedgroupandonemonth after loading in early group. In the immediate group,