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16 I I research _ dental implant loading implants3_2010 one patient lost both distal implants five months af- ter loading. In two other patients, distal implants failed after one year of loading. Marginal bone loss was the highest for the immediate group. In another study18 , there has been reported a success rate of 90.3 %, i.e. 47 lost implants out of 477 inserted im- plants, respectively. It might be important to specify thatBiconimplantswereusedinthestudy.Itisworth mentioningthat,ingeneral,thesuccessratewashigh (95.6 % – 100 %), a fact confirming immediate and early loading of dental implants to be a viable treat- ment option.7,8,9,10,11,12,13,14,16,17,19,20 Marginal bone loss was observed to be higher with immediately loaded implants.15 Furtheron, bone loss has not been ex- tended beyond the first implant thread.13,16 Both im- plant length reducing and diameter shortening in- crease the risk of failure.9 Another important aspect is that immediate loading can be achieved under cir- cumstances of a high primary stability.8,9,10,11,12,13,14,15, 16,17,18,19,20 _Conclusion and Clinical Relevance Nowadays,immediateandearlyloadingwithout- comescomparabletoconventionalresultsispossible. However,arigurouslyandthoroughlyselectedsurgi- cal and prothetic management is of utmost impor- tance and necessity in achieving the goal. It is also compulsory for dental implants to show a very good primary stability and bone quantitaty and quality as well as bruxism and parafunctional habits must be correctly assessed. The risk of failure with immediate andearlyloadingisextremelyhighinthelateralmax- illary area due to poor bone quality as well as when one tooth only is replaced. A high success rate has been observed when optimum density bone exists and when the implants are splinted. Biological limits in the immediate and early loading process of dental implants have not been entirely defined yet. Further researchesarerequiredandimportantforamoreac- curatesettingoflimitsbetweenimmediate,earlyand delayed loading of dental implants. _Summary Thescopeofthisreviewistofindananswertothe questions “when” and “how” implants can be loaded in different time after insertion. For the purpose of this review, immediate loading was defined as an im- plant put in function within 48 hours after its place- ment;earlyloadingasthoseimplantsputinfunction from 48 hours up to 3 months after insertion, and conventional loading as those implants put in func- tion between 3 to 6 months after placement. The re- view has been accomplished on the basis of 14 stud- iesselectedoutof26,withaminimum12monthfol- lowup.Theconcernforimmediateorearlyloadingaf- ter insertion determines special and specific clinical implications with an impact on the treatment time since it is shortened to a very large extent, being thus a benefit to the patients. Themainpurposeofthestudiesunderlyingthisre- view is in fact the success of the final prothesis, since implantslossengendersagreatriskforprotheses.Im- mediate or early loading of dental implants is nowa- days possible for carefully selected patients. All knownriskfactorsandcontraindicationsforosseoin- tegration with a standard protocol will be equally or evenmoreimportantwithimmediateorearlyloading protocols. It is thus implied that successful osseoin- tegration with reduced loading protocols requires critical case selection and meticulous surgical and prosthetic management. A surgical technique that minimizesheatgenerationandpressurenecrosisisof particularimportancewithbothearlyandimmediate implant loading. It is also dependent on the quality and quantity of existing bone at the implant site and theabilitytoachieveandmaintainadequatestability of the implant so that micromotion is kept below the biological threshold. The level of skill and experience of the surgeon play a role in treatment outcomes. Bi- ological limits in the immediate and early loading processofdentalimplantshavenotbeenentirelyde- fined yet. Further researches are required and impor- tantforamoreaccuratesettingoflimitsbetweenim- mediate,earlyanddelayedloadingofdentalimplants. ForreviewingthisarticleandthesupportIthank DrRolandHille,DrRolfVollmerandDrMazenTamimi. Citedliteratureuponrequest. Dr Marius Hary Silvasan str.Romulus nr.34A 300238Timisoara,Romania Phone:+40 722 367 490 Fax:+40 256 294 085 _contact implants