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BMC Oral Health

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Open Access 01-12-2021 | Research article

Effects of immediate and delayed loading protocols on marginal bone loss around implants in unsplinted mandibular implant-retained overdentures: a systematic review and meta-analysis

Authors: Wei Liu, He Cai, Junjiang Zhang, Jian Wang, Lei Sui

Published in: BMC Oral Health | Issue 1/2021

Abstract

Background

Immediate loading has recently been introduced into unsplinted mandibular implant-retained overdentures for the management of edentulous patients due to their increasing demand on immediate aesthetics and function. However, there is still a scarcity of meta-analytical evidence on the efficacy of immediate loading compared to delayed loading in unsplinted mandibular implant-retained overdentures. The purpose of this study was to compare the marginal bone loss (MBL) around implants between immediate and delayed loading of unsplinted mandibular implant-retained overdentures.

Methods

Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and cohort studies quantitatively comparing the MBL around implants between immediate loading protocol (ILP) and delayed loading protocol (DLP) of unsplinted mandibular overdentures were included. A systematic search was carried out in PubMed, EMBASE, and CENTRAL databases on December 02, 2020. “Grey” literature was also searched. A meta-analysis was conducted to compare the pooled MBL of two different loading protocols of unsplinted mandibular overdentures through weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). The subgroup analysis was performed between different attachment types (i.e. Locator attachment vs. ball anchor). The risk of bias within and across studies were assessed using the Cochrane Collaboration’s tool, the Newcastle–Ottawa scale, and Egger’s test.

Results

Of 328 records, five RCTs and two cohort studies were included and evaluated, which totally contained 191 participants with 400 implants. The MBL of ILP group showed no significant difference with that of DLP group (WMD 0.04, CI − 0.13 to 0.21, P > .05). The subgroup analysis revealed similar results with Locator attachments or ball anchors (P > .05). Apart from one RCT (20%) with a high risk of bias, four RCTs (80%) showed a moderate risk of bias. Two prospective cohort studies were proved with acceptable quality. Seven included studies have reported 5.03% implant failure rate (10 of 199 implants) in ILP group and 1.00% failure rate (2 of 201 implants) in DLP group in total.

Conclusions

For unsplinted mandibular implant-retained overdentures, the MBL around implants after ILP seems comparable to that of implants after DLP. Immediate loading may be a promising alternative to delayed loading for the management of unsplinted mandibular implant-retained overdentures.

PROSPERO registration number: CRD42020159124.

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Geckili O, Bilhan H, Mumcu E, Dayan C, Yabul A, Tuncer N. Comparison of patient satisfaction, quality of life, and bite force between elderly edentulous patients wearing mandibular two implant-supported overdentures and conventional complete dentures after 4 years. Spec Care Dentist. 2012;32(4):136–41. https://doi.org/10.1111/j.1754-4505.2012.00258.x.CrossRefPubMed

Hobkirk JA, Abdel-Latif HH, Howlett J, Welfare R, Moles DR. Prosthetic treatment time and satisfaction of edentulous patients treated with conventional or implant-stabilized complete mandibular dentures: a case-control study (part 2). Int J Prosthodont. 2009;22(1):13–9.PubMed

Hasegawa T, Kawabata S, Takeda D, Iwata E, Saito I, Arimoto S, et al. Survival of Brånemark System Mk III implants and analysis of risk factors associated with implant failure. Int J Oral Maxillofac Surg. 2017;46(2):267–73. https://doi.org/10.1016/j.ijom.2016.10.014.CrossRefPubMed

Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, et al. The McGill consensus statement on overdentures. Montreal, Quebec Canada. Int J Prosthodont. 2002;15(4):413–4.PubMed

Thomason JM, Feine J, Exley C, Moynihan P, Müller F, Naert I, et al. Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients—the York Consensus Statement. Br Dent J. 2009;207(4):185–6. https://doi.org/10.1038/sj.bdj.2009.728.CrossRefPubMed

Beikler T, Flemmig TF. EAO consensus conference: economic evaluation of implant-supported prostheses. Clin Oral Implants Res. 2015;26(Suppl 11):57–63. https://doi.org/10.1111/clr.12630.CrossRefPubMed

Kleis WK, Kämmerer PW, Hartmann S, Al-Nawas B, Wagner W. A comparison of three different attachment systems for mandibular two-implant overdentures: one-year report. Clin Implant Dent Relat Res. 2010;12(3):209–18. https://doi.org/10.1111/j.1708-8208.2009.00154.x.CrossRefPubMed

de Souza Batista VE, Verri FR, Lemos CAA, Cruz RS, Oliveira HFF, Gomes JML, et al. Should the restoration of adjacent implants be splinted or nonsplinted? A systematic review and meta-analysis. J Prosthet Dent. 2019;121(1):41–51. https://doi.org/10.1016/j.prosdent.2018.03.004.CrossRefPubMed

Carlsson GE, Kronström M, de Baat C, Cune M, Davis D, Garefis P, et al. A survey of the use of mandibular implant overdentures in 10 countries. Int J Prosthodont. 2004;17(2):211–7.PubMed

10.

Naert I, Alsaadi G, Quirynen M. Prosthetic aspects and patient satisfaction with two-implant-retained mandibular overdentures: a 10-year randomized clinical study. Int J Prosthodont. 2004;17(4):401–10.PubMed

11.

Timmerman R, Stoker GT, Wismeijer D, Oosterveld P, Vermeeren JI, van Waas MA. An eight-year follow-up to a randomized clinical trial of participant satisfaction with three types of mandibular implant-retained overdentures. J Dent Res. 2004;83(8):630–3. https://doi.org/10.1177/154405910408300809.CrossRefPubMed

12.

Albrektsson T, Jacobsson M. Bone–metal interface in osseointegration. J Prosthet Dent. 1987;57(5):597–607. https://doi.org/10.1016/0022-3913(87)90344-1.CrossRefPubMed

13.

Brånemark PI, Adell R, Albrektsson T, Lekholm U, Lundkvist S, Rockler B. Osseointegrated titanium fixtures in the treatment of edentulousness. Biomaterials. 1983;4(1):25–8. https://doi.org/10.1016/0142-9612(83)90065-0.CrossRefPubMed

14.

Schatzker J, Horne JG, Sumner-Smith G. The effect of movement on the holding power of screws in bone. Clin Orthop Relat Res. 1975;111:257–62. https://doi.org/10.1097/00003086-197509000-00032.CrossRef

15.

Cochran DL, Morton D, Weber HP. Consensus statements and recommended clinical procedures regarding loading protocols for endosseous dental implants. Int J Oral Maxillofac Implants. 2004;19(Suppl):109–13.PubMed

16.

Chiapasco M, Gatti C. Implant-retained mandibular overdentures with immediate loading: a 3- to 8-year prospective study on 328 implants. Clin Implant Dent Relat Res. 2003;5(1):29–38. https://doi.org/10.1111/j.1708-8208.2003.tb00179.x.CrossRefPubMed

17.

Roberts WE, Smith RK, Zilberman Y, Mozsary PG, Smith RS. Osseous adaptation to continuous loading of rigid endosseous implants. Am J Orthod. 1984;86(2):95–111. https://doi.org/10.1016/0002-9416(84)90301-4.CrossRefPubMed

18.

Cannizzaro G, Leone M, Esposito M. Immediate functional loading of implants placed with flapless surgery in the edentulous maxilla: 1-year follow-up of a single cohort study. Int J Oral Maxillofac Implants. 2007;22(1):87–95.PubMed

19.

Akkocaoglu M, Uysal S, Tekdemir I, Akca K, Cehreli MC. Implant design and intraosseous stability of immediately placed implants: a human cadaver study. Clin Oral Implants Res. 2005;16(2):202–9. https://doi.org/10.1111/j.1600-0501.2004.01099.x.CrossRefPubMed

20.

Fanuscu MI, Chang TL, Akça K. Effect of surgical techniques on primary implant stability and peri-implant bone. J Oral Maxillofac Surg. 2007;65(12):2487–91. https://doi.org/10.1016/j.joms.2007.04.017.CrossRefPubMed

21.

Borges TF, Mendes FA, de Oliveira TR, Gomes VL, do Prado CJ, das Neves FD. Mandibular overdentures with immediate loading: satisfaction and quality of life. Int J Prosthodont. 2011;24(6):534–9.

22.

Erkapers M, Ekstrand K, Baer RA, Toljanic JA, Thor A. Patient satisfaction following dental implant treatment with immediate loading in the edentulous atrophic maxilla. Int J Oral Maxillofac Implants. 2011;26(2):356–64.PubMed

23.

Esposito M, Grusovin MG, Willings M, Coulthard P, Worthington HV. The effectiveness of immediate, early, and conventional loading of dental implants: a Cochrane systematic review of randomized controlled clinical trials. Int J Oral Maxillofac Implants. 2007;22(6):893–904.PubMed

24.

Goiato MC, Bannwart LC, Pesqueira AA, Santos DM, Haddad MF, Santos MR, et al. Immediate loading of overdentures: systematic review. Oral Maxillofac Surg. 2014;18(3):259–64. https://doi.org/10.1007/s10006-013-0421-6.CrossRefPubMed

25.

Sanz-Sánchez I, Sanz-Martín I, Figuero E, Sanz M. Clinical efficacy of immediate implant loading protocols compared to conventional loading depending on the type of the restoration: a systematic review. Clin Oral Implants Res. 2015;26(8):964–82. https://doi.org/10.1111/clr.12428.CrossRefPubMed

26.

Zarb GA, Albrektsson T. Consensus report: towards optimized treatment outcomes for dental implants. J Prosthet Dent. 1998;80(6):641. https://doi.org/10.1016/s0022-3913(98)70048-4.CrossRefPubMed

27.

Koutsonikos A. Implants: success and failure—a literature review. Ann R Australas Coll Dent Surg. 1998;14:75–80.PubMed

28.

Roos-Jansåker AM, Lindahl C, Renvert H, Renvert S. Nine- to fourteen-year follow-up of implant treatment. Part II: presence of peri-implant lesions. J Clin Periodontol. 2006;33(4):290–5. https://doi.org/10.1111/j.1600-051X.2006.00906.x.CrossRefPubMed

29.

Tarnow DP, Cho SC, Wallace SS. The effect of inter-implant distance on the height of inter-implant bone crest. J Periodontol. 2000;71(4):546–9. https://doi.org/10.1902/jop.2000.71.4.546.CrossRefPubMed

30.

Papaspyridakos P, Chen CJ, Singh M, Weber HP, Gallucci GO. Success criteria in implant dentistry: a systematic review. J Dent Res. 2012;91(3):242–8. https://doi.org/10.1177/0022034511431252.CrossRefPubMed

31.

Naert I, Duyck J, Hosny M, Jacobs R, Quirynen M, van Steenberghe D. Evaluation of factors influencing the marginal bone stability around implants in the treatment of partial edentulism. Clin Implant Dent Relat Res. 2001;3(1):30–8. https://doi.org/10.1111/j.1708-8208.2001.tb00126.x.CrossRefPubMed

32.

Misch CE, Perel ML, Wang HL, Sammartino G, Galindo-Moreno P, Trisi P, et al. Implant success, survival, and failure: the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. Implant Dent. 2008;17(1):5–15. https://doi.org/10.1097/ID.0b013e3181676059.CrossRefPubMed

33.

Kline R, Hoar JE, Beck GH, Hazen R, Resnik RR, Crawford EA. A prospective multicenter clinical investigation of a bone quality-based dental implant system. Implant Dent. 2002;11(3):224–34. https://doi.org/10.1097/00008505-200207000-00006.CrossRefPubMed

34.

Esposito M, Grusovin MG, Maghaireh H, Worthington HV. Cochrane Database Syst Rev. 2013;3:Cd003878. https://doi.org/10.1002/14651858.CD003878.pub5.CrossRef

35.

Chen J, Cai M, Yang J, Aldhohrah T, Wang Y. Immediate versus early or conventional loading dental implants with fixed prostheses: a systematic review and meta-analysis of randomized controlled clinical trials. J Prosthet Dent. 2019;122(6):516–36. https://doi.org/10.1016/j.prosdent.2019.05.013.CrossRefPubMed

36.

van Steenberghe D, Molly L, Jacobs R, Vandekerckhove B, Quirynen M, Naert I. The immediate rehabilitation by means of a ready-made final fixed prosthesis in the edentulous mandible: a 1-year follow-up study on 50 consecutive patients. Clin Oral Implants Res. 2004;15(3):360–5. https://doi.org/10.1111/j.1600-0501.2004.01069.x.CrossRefPubMed

37.

De Bruyn H, Raes S, Ostman PO, Cosyn J. Immediate loading in partially and completely edentulous jaws: a review of the literature with clinical guidelines. Periodontol 2000. 2014;66(1):153–87. https://doi.org/10.1111/prd.12040.CrossRefPubMed

38.

Chrcanovic BR, Albrektsson T, Wennerberg A. Immediately loaded non-submerged versus delayed loaded submerged dental implants: a meta-analysis. Int J Oral Maxillofac Surg. 2015;44(4):493–506. https://doi.org/10.1016/j.ijom.2014.11.011.CrossRefPubMed

39.

Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011. https://doi.org/10.1136/bmj.d5928.CrossRefPubMedPubMedCentral

40.

Higgins JPT TJ, Chandler J, Cumpston M, Li T, Page MJ and Welch VA. Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated August 2019). Cochrane. 2019.

41.

Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5. https://doi.org/10.1007/s10654-010-9491-z.CrossRefPubMed

42.

Borenstein M, Hedges L, Higgins JPT, Rothstein HR. Fixed-effect versus random-effects models. In: Borenstein M, Hedges LV, Higgins JPT, Rothstein HR, editors. Introduction to meta-analysis. Hoboken: Wiley; 2009. p. 77–86. https://doi.org/10.1002/9780470743386.ch13.CrossRef

43.

Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34. https://doi.org/10.1136/bmj.315.7109.629.CrossRefPubMedPubMedCentral

44.

Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefPubMed

45.

Kutkut A, Rezk M, Zephyr D, Dawson D, Frazer R, Al-Sabbagh M. Immediate loading of unsplinted implant retained mandibular overdenture: a randomized controlled clinical study. J Oral Implantol. 2019;45(5):378–89. https://doi.org/10.1563/aaid-joi-D-18-00202.CrossRefPubMed

46.

Aunmeungtong W, Kumchai T, Strietzel FP, Reichart PA, Khongkhunthian P. Comparative clinical study of conventional dental implants and mini dental implants for mandibular overdentures: a randomized clinical trial. Clin Implant Dent Relat Res. 2017;19(2):328–40. https://doi.org/10.1111/cid.12461.CrossRefPubMed

47.

Schincaglia GP, Rubin S, Thacker S, Dhingra A, Trombelli L, Ioannidou E. Marginal bone response around immediate- and delayed-loading implants supporting a locator-retained mandibular overdenture: a randomized controlled study. Int J Oral Maxillofac Implants. 2016;31(2):448–58. https://doi.org/10.11607/jomi.4118.CrossRefPubMed

48.

Elsyad MA, Elsaih EA, Khairallah AS. Marginal bone resorption around immediate and delayed loaded implants supporting a locator-retained mandibular overdenture. A 1-year randomised controlled trial. J Oral Rehabil. 2014;41(8):608–18. https://doi.org/10.1111/joor.12182.CrossRefPubMed

49.

Elsyad MA, Al-Mahdy YF, Fouad MM. Marginal bone loss adjacent to conventional and immediate loaded two implants supporting a ball-retained mandibular overdenture: a 3-year randomized clinical trial. Clin Oral Implants Res. 2012;23(4):496–503. https://doi.org/10.1111/j.1600-0501.2011.02173.x.CrossRefPubMed

50.

De Smet E, Duyck J, Vander Sloten J, Jacobs R, Naert I. Timing of loading–immediate, early, or delayed–in the outcome of implants in the edentulous mandible: a prospective clinical trial. Int J Oral Maxillofac Implants. 2007;22(4):580–94.PubMed

51.

Turkyilmaz I, Tozum TF, Fuhrmann DM, Tumer C. Seven-year follow-up results of TiUnite implants supporting mandibular overdentures: early versus delayed loading. Clin Implant Dent Relat Res. 2012;14(Suppl 1):e83-90. https://doi.org/10.1111/j.1708-8208.2011.00365.x.CrossRefPubMed

52.

Aziz O, Constantinides V, Tekkis PP, Athanasiou T, Purkayastha S, Paraskeva P, et al. Laparoscopic versus open surgery for rectal cancer: a meta-analysis. Ann Surg Oncol. 2006;13(3):413–24. https://doi.org/10.1245/aso.2006.05.045.CrossRefPubMed

53.

Wei Y, Xu G, Zhang G, Wen C, Anwar F, Wang S, et al. Antigenic evolution of H9N2 chicken influenza viruses isolated in China during 2009–2013 and selection of a candidate vaccine strain with broad cross-reactivity. Vet Microbiol. 2016;182:1–7. https://doi.org/10.1016/j.vetmic.2015.10.031.CrossRefPubMed

54.

Newton HJ. sbe24. metan—an alternative meta-analysis command. Stata Technical Bulletin, p. 4–14. 1998.

55.

Alfadda SA, Attard NJ, David LA. Five-year clinical results of immediately loaded dental implants using mandibular overdentures. Int J Prosthodont. 2009;22(4):368–73.PubMed

56.

Celik G, Uludag B. Photoelastic stress analysis of various retention mechanisms on 3-implant-retained mandibular overdentures. J Prosthet Dent. 2007;97(4):229–35. https://doi.org/10.1016/j.prosdent.2007.02.006.CrossRefPubMed

57.

Naert I, Gizani S, van Steenberghe D. Bone behavior around sleeping and non-sleeping implants retaining a mandibular hinging overdenture. Clin Oral Implants Res. 1999;10(2):149–54. https://doi.org/10.1034/j.1600-0501.1999.100209.x.CrossRefPubMed

58.

Helmy MHE, Alqutaibi AY, El-Ella AA, Shawky AF. Effect of implant loading protocols on failure and marginal bone loss with unsplinted two-implant-supported mandibular overdentures: systematic review and meta-analysis. Int J Oral Maxillofac Surg. 2018;47(5):642–50. https://doi.org/10.1016/j.ijom.2017.10.018.CrossRefPubMed

59.

Qi MC, Zou SJ, Han LC, Zhou HX, Hu J. Expression of bone-related genes in bone marrow MSCs after cyclic mechanical strain: implications for distraction osteogenesis. Int J Oral Sci. 2009;1(3):143–50. https://doi.org/10.4248/ijos.09021.CrossRefPubMedPubMedCentral

60.

Vandamme K, Naert I, Geris L, Sloten JV, Puers R, Duyck J. Histodynamics of bone tissue formation around immediately loaded cylindrical implants in the rabbit. Clin Oral Implants Res. 2007;18(4):471–80. https://doi.org/10.1111/j.1600-0501.2007.01339.x.CrossRefPubMed

61.

Duyck J, Slaets E, Sasaguri K, Vandamme K, Naert I. Effect of intermittent loading and surface roughness on peri-implant bone formation in a bone chamber model. J Clin Periodontol. 2007;34(11):998–1006. https://doi.org/10.1111/j.1600-051X.2007.01135.x.CrossRefPubMed

62.

Tal H, Artzi Z, Moses O, Nemcovsky CE, Kozlovsky A. Spontaneous early exposure of submerged endosseous implants resulting in crestal bone loss: a clinical evaluation between stage I and stage II surgery. Int J Oral Maxillofac Implants. 2001;16(4):514–21.PubMed

63.

Randow K, Ericsson I, Nilner K, Petersson A, Glantz PO. Immediate functional loading of Brånemark dental implants. An 18-month clinical follow-up study. Clin Oral Implants Res. 1999;10(1):8–15. https://doi.org/10.1034/j.1600-0501.1999.100102.x.CrossRefPubMed

64.

Assad AS, Hassan SA, Shawky YM, Badawy MM. Clinical and radiographic evaluation of implant-retained mandibular overdentures with immediate loading. Implant Dent. 2007;16(2):212–23. https://doi.org/10.1097/ID.0b013e318065a95f.CrossRefPubMed

65.

Kern JS, Kern T, Wolfart S, Heussen N. A systematic review and meta-analysis of removable and fixed implant-supported prostheses in edentulous jaws: post-loading implant loss. Clin Oral Implants Res. 2016;27(2):174–95. https://doi.org/10.1111/clr.12531.CrossRefPubMed

66.

Nkenke E, Fenner M. Indications for immediate loading of implants and implant success. Clin Oral Implants Res. 2006;17(Suppl 2):19–34. https://doi.org/10.1111/j.1600-0501.2006.01348.x.CrossRefPubMed

67.

Li FB, Yu LY, Cai YD, Xie C. Jaw bone density assessments of implant sites using spiral CT and Simplant software. Shanghai Kou Qiang Yi Xue. 2009;18(1):52–5.PubMed

68.

Salman A, Thacker S, Rubin S, Dhingra A, Ioannidou E, Schincaglia GP. Immediate versus delayed loading of mandibular implant-retained overdentures: a 60-month follow-up of a randomized clinical trial. J Clin Periodontol. 2019;46(8):863–71. https://doi.org/10.1111/jcpe.13153.CrossRefPubMed

69.

Galindo-Moreno P, León-Cano A, Ortega-Oller I, Monje A, O’Valle F, Catena A. Marginal bone loss as success criterion in implant dentistry: beyond 2 mm. Clin Oral Implants Res. 2015;26(4):e28–34. https://doi.org/10.1111/clr.12324.CrossRefPubMed

70.

Ntounis A, Petropoulou A. A technique for managing and accurate registration of periimplant soft tissues. J Prosthet Dent. 2010;104(4):276–9. https://doi.org/10.1016/s0022-3913(10)60139-4.CrossRefPubMed

71.

Acharya A, Leung MCT, Ng KT, Fan MHM, Fokas G, Mattheos N. Peri-implant marginal bone loss rate pre- and post-loading: an exploratory analysis of associated factors. Clin Oral Implants Res. 2019;30(5):410–9. https://doi.org/10.1111/clr.13424.CrossRefPubMed

Title: Effects of immediate and delayed loading protocols on marginal bone loss around implants in unsplinted mandibular implant-retained overdentures: a systematic review and meta-analysis
Authors: Wei Liu
He Cai
Junjiang Zhang
Jian Wang
Lei Sui
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Oral Health / Issue 1/2021
Electronic ISSN: 1472-6831
DOI: https://doi.org/10.1186/s12903-021-01486-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of immediate and delayed loading protocols on marginal bone loss around implants in unsplinted mandibular implant-retained overdentures: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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