IM0310

I 07 research _ dental implant loading I implants3_2010 calimplication,thecurrentevidencebasedliterature and the factors that might influence their outcomes. There is a growing body of published literature sup- porting reduced implant loading times. Abutment connection and placement of a restoration in occlu- sionwiththeopposingdentitionofanimplantatthe timeofsurgeryorwithin48hoursofplacementisre- ferred to as “immediate loading” The functional restoration of an implant from 48 hours up to 3 months after placement has been defined as “early loading”.5 Both the immediate and early functional loading of implants before lamellar bone formation carry an inherent biological risk. Shortened loading protocolsmayexposethehealingbonetoimplantin- terfacetomechanicaloverloadasdescribedinWollfs Law and Frosts Mechanostat theory (Fig. 4). Interfacial micromotion above the biological thresholdcanresultinthesubsequentlossofimplant stability. Rough titanium surfaces offer better im- plant anchorage in bone and more rapid bone depo- sition.6 The general applicability of these principles will be considered as to their biological implications, the current evidence base and the factors that influ- ence their results. _Materials and Methods Clinical reports on dental implants found in major scientific journals and through searching in PUB MED, QUINTESSENZ and MED-LINE, have served as the basis for this review. The following search terms, alone or in combination, were used: implant loading, immediate loading, early loading, delayed loading. After screening the titles and abstracts for possible relevance, they were ordered in full text. We also screened reference list of publications and relevant systematicreviews.Tominimisebias,onlyRCTsofos- seointegrateddentalimplantswereconsidered.Tobe included, RCTs had to compare the same osseointe- gratedimplantsloadedatdifferenttimesforaperiod of at least 12 months of loading. For the purpose of this review immediate loading was defined as an implant put in function within 48 hours after its placement; early loading as those im- plants put in function from 48 hours up to 3 months after placement, and conventional loading as those implantsputinfunctionbetween3to6monthsafter insertion. Implant mobility and removal of stable im- plants dictated by progressive marginal bone loss or infection have been assessed. Implant mobility of in- dividualimplantscouldbeassessed manuallyorwith devices such as Periotest® (Siemens, Munich, Ger- many) or Resonance frequency—Analysis—Osstell® (Integration diagnostics, Göteborg, Sweden). In our search we aimed at including randomized controlled trials.Mostclinicalreportswereonafewimplantsys- tems only and threaded commercially pure titanium implants ad modum Brånemark dominated the liter- ature. The quality assessment of the included trials wasundertakenindependently.Thefollowingquality criteria were examined: Allocation concealment was recorded as ade- quate(A),unclear(B),orinadequate(C),asdescribed elsewhere[Higgins,GreenS.Handbookforsystematic reviews of interventions]. Allocationconcealmentwasconsideredadequate ifitwascentralized(e.g.Allocationbyacentraloffice unaware of subject characteristics). If randomization was pharmacy controlled; if prenumbered or coded identical containers were administered serially to participants. A score of A was recorded if there was a clear ex- planationforawithdrawalsordropoutsineachtreat- ment group or if there were no dropouts. If clear ex- planationforanydropoutsweregiven,theriskofbias of the assessment of reasons for dropping out was evaluated. A “strong scientific basis” is required as well. A score of B was recorded if clear explanations for any dropouts or withdrawals were not provided. Articles or authors that stated that allocation con- cealment procedures were implemented but did not provide details on how this was accomplished were coded as unclear. A score of C was recorded if there Fig. 3_Immediate temporization and delayed loading. Fig.4_Loading zones acc. to H. M. Frost Fig. 3 Fig. 4