WORKSHOP ON THE STATE OF THE SCIENCE OF IMPLANT DENTISTRY. Chicago August 2006

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1 WORKSHOP ON THE STATE OF THE SCIENCE OF IMPLANT DENTISTRY. Chicago August 2006 Group 1. What Is the Effect on Outcomes of Time to Loading of a Fixed or Removable Prosthesis Placed on Implant(s)?

2 How does immediate loading compare in success to conventional loading? : Close to 200 papers reporting clinical data About 25 papers reporting comparative data from 20 trials 175 papers single cohort studies and case reports Since 2000: 18 (!) systematic reviews

3 mmediate loading of implants is: A. More successful and predictive as conventional loading? B. Equally successful but less predictive than conventional loading? C. Equally successful and predictive as conventional loading? D. Slightly less successful than conventional loading, but predictive? E. Less successful and predictive than conventional loading?

4 Immediate loading 2000 (1) Szmukler-Moncler S, Piattelli A, Favero GA, Dubruille JH. Considerations preliminary to the application of early and immediate loading protocols in dental implantology. Clin Oral Implants Res 2000; 11:

5 Immediate loading 2003 (3) (total: 4) Aparicio C, Rangert B, Sennerby L. Immediate/early loading of dental implants: a report from the Sociedad Espanola de Implantes World Congress consensus meeting in Barcelona, Spain, Clin Implant Dent Relat Res 2003; 5: Gapski R, Wang HL, Mascarenhas P, Lang NP. Critical review of immediate implant loading. Clin Oral Implants Res 2003; 14: Lekholm U. Immediate/early loading of oral implants in compromised patients. Periodontol ; 33:

6 Immediate loading 2004 (10) (total: 14) Castellon P, Block MS, Smith MB, Finger IM. Immediate loading of the edentulous mandible: delivery of the final restoration or a provisional restoration--which method to use? J Oral Maxillofac Surg 2004; 62(Sup 2): Chiapasco M. Early and immediate restoration and loading of implants in completely edentulous patients. Int J Oral Maxillofac Implants 2004; 19(Sup): 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(Sup):

7 Immediate loading 2004 (10) (total: 14) Esposito, Worthington, Thomsen P, Coulthard P. different times for loading dental implants. Cochrane SR 2004; 3: CD Ganeles J, Wismeijer D. Early and immediately restored and loaded dental implants for single-tooth and partial-arch applications. Int J Oral Maxillofac Impl 2004; 19(Sup): Misch CE, Hahn J, Judy KW, Lemons JE, Linkow LI, Lozada JL, Mills E, Misch CM, Salama H, Sharawy M, Testori T, Wang HL; Immediate Function Consensus Conference. Workshop guidelines on immediate loading in implant dentistry. November 7, J Oral Implantol 2004; 30:

8 Immediate loading 2004 (10) (total: 14) Misch CE, Wang HL, Misch CM, Sharawy M, Lemons J, Judy KW. Rationale for the application of immediate load in implant dentistry: part I. Implant Dent. 2004; 13: & part II. Implant Dent 2004;13: Morton D, Jaffin R, Weber HP. Immediate restoration and loading of dental implants: clinical considerations and protocols. Int J Oral Maxillofac Implants 2004; 19(Sup): Romanos GE. Present status of immediate loading of oral implants. J Oral Implantol 2004; 30:

9 Immediate loading 2005 (2) (total: 16) Attard NJ, Zarb GA. Immediate and early implant loading protocols: a literature of clinical studies. J Prosthet Dent 2005; 94: Ioannidou E, Doufexi A. Does loading time affect implant survival? A meta-analysis of 1,266 implants. J Periodontol 2005; 76:

10 Immediate loading 2006 (2) (total: 18) Nkenke E, Fenner M. Indications for immediate loading of implants and implant success. Clin Oral Implants Res 2006; 17(Sup 2): Jokstad, Carr A. What is the effect on outcomes of time-to-loading of a fixed or removable prosthesis placed on implant(s)? Int J Oral Maxillofac Implants 2007; 21(Sup): in press.

11 How does immediate loading compare in success to conventional loading? A. When conclusions in systematic reviews are consistent B. Only RCT trials can answer and they favour one of the protocols C. When many cohort studies have compared outcomes following immediate and conventional loading protocols D. When many case series have shown excellent outcomes following immediate loading E. The answer can be extrapolated from different study results

12 Immediate loading: How does immediate loading compare in success to conventional loading? Close to 200 papers reporting clinical data 175 papers single cohort studies / case reports Comparative data from 25 papers/20 trials Since 2000: 18 systematic reviews 17 of the 18 SR reviews did not adequately address the question above NEED TO FOCUS ON PICO-QUESTION: PROBLEM/ INTERVENTION/ COMPARATIVE INTERVENTION/ OUTCOME

14 Results 1/2 22 papers, published between 1990 and trials were randomized controlled trials, 13 were prospective with concurrent controls, and 2 were retrospective with concurrent controls. (1) the methodologic rigor of the trials was often not very strong, (2) the reported treatment outcomes were mostly surrogate rather than patientcentered (3) the follow-up times were relatively short.

15 Jokstad, Carr A. Int J Oral Maxillofac Implants 2006; 21(Sup): in press. N=22 trials

16 Jokstad, Carr A. What is the effect on outcomes of time-to-loading of a fixed or removable prosthesis placed on implant(s)? Int J Oral Maxillofac Implants 2006; 21(Sup): in press. N=22 trials

17 Jokstad, Carr A. What is the effect on outcomes of time-to-loading of a fixed or removable prosthesis placed on implant(s)? Int J Oral Maxillofac Implants 2006; 21(Sup): in press. N=22 trials

18 Results 2/2 There was a slight tendency toward better results in the control group. The pairwise test indicated a pooled difference of 2% (CI: 0% to 4%, z = 1.91, P =.06). Statistical comparisons between subgroups were considered inappropriate because of the heterogeneity of trials. Data from 19 trials reporting different patient follow-up periods between 1 and 10 years suggest that the overall performance was not significantly different between immediate or early loaded implants versus implants using a conventional loading period.

19 Conclusions Within the limitations of the study populations in the papers appraised in this systematic review, there are no indications that immediate or early loading is not a safe procedure.

Consensus Statements and Recommended Clinical Procedures Regarding Loading Protocols

Group 3 Consensus Statements Consensus Statements and Recommended Clinical Procedures Regarding Loading Protocols Hans-Peter Weber, DMD, Dr Med Dent 1 /Dean Morton, BDS, MS 2 /German O. Gallucci, DMD,