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06 I I research _ dental implant loading Fig. 1_Direct loading at placement and delayed loading after bone healing. Fig. 2_Conventional implant protocol without any loading performing the prosthetic in part after bone healing (e.g. Brånemark protocol). implants3_2010 _Osseointegration is the processbywhichliving boneattachestotheartificialsurfaceofanimplantby the formation of bony tissue without growth of fi- brous tissue at the bone-implant interface. _Introduction Osseointegration is a highly dynamic process, which does not only address the formation of bone onto an implantsurfaceafterithasbeenplaced,butitalsoad- dressestheremodellingormaintenanceofbonedur- ing the life of the implant. The long term success of an implant treatment is theoreticallydeterminedbyfactorsrelatedtothepa- tient, the implant components and the treating clini- cians.1 BeforetheintroductionoftheProf.Brånemark protocol, dental implants were commonly loaded at placement because immediate bone stimulation was considered to avoid crestal bone loss (Fig.1).2 The cli- nicianisoftenfacedwiththechallengeofidentifying the successful osseointegration of implant. Clinical success is often determined by a lack of mobility and ability of the implant to resist functional loading.3 Radiographically,boneshouldappeartobeclosely apposed to the implant surface. The current achiev- able resolution obtained in medical imaging, how- ever,isabout10timeslessthanwhatisrequiredtoob- serve a soft tissue cell. Therefore, radiographic as- sessment alone is unsuitable to determine with cer- taintyifasofttissuelayerispresent.Whenanimplant isexposedtoexcessivemicromotionatthebone-im- plant interface during healing, fibrous tissue encap- sulation of the implant rather than osseointegration may occur. Conventional implant protocols have been based on the achievement of primary stability and prolonged non-loaded healing periods (Fig. 2).4 That was achieved by a two stage technique and an unloaded healing period of three to six months. Delayedimplantloadingwasempiricallybasedonthe beliefthatthetransferofanymicromotiontotheim- plant surface during healing would result in fibrous encapsulation rather than osseointegration. A per- ceived psychological, economical and functional ad- vantage of shortened treatment periods has encour- agedclinicianstochallengethisconventionwithim- mediate temporization (Fig. 3) and/or the early and immediate loading of dental implants. Therelativemeritsoftheseshortenedloadingpro- tocols will be discussed with respect to their biologi- Timing of dental implant loading A Literature Review Author_Dr Marius Hary Silvasan, Romania Fig. 1 Fig. 2