ISSN : 0376-4672
A titanium based screw shaped dental implant was first introduced by Branemark and a treatment protocol where the restoration of edentulous area by connecting abutment after the osseointegration of the titanium surface of the implant and surrounding bone structure has been proposed. Although this protocol is widely accepted as a standard up to date, the healing duration of 3-6 months as well as the need for provisional prostheses during this period present as a major drawback. Immediate loading has been accomplished through the advent of various implant designs, enforced surface treatments, diverse forms of abutment, and delicate surgical techniques together with the increase in demand from the patients. The success rate of the immediate loading technique has been first reported as 85.7% by Dr. Schnitman in 1990 which recently has been reported up to 100% in the case of immediate loading in single tooth by Dr. Kan. To ameliorate the success rate of immediate loading technique, selection of patients presenting a sound bone quality and quantity, acquiring primary stability through delicate surgical techniques and fabrication of prostheses which accounts for biological stabilities should all be taken into consideration. This presentation introduces the understanding of biological stability of immediate loading, various methods for measurement of stability and clinical cases regarding immediate loading technique..
Nowadays, it seems like that the concept of the early loading protocol has been intruded between the concept of the immediate loading supported by advanced clinicians and the concept of the conventional loading supported by the prudent clinicians. In particular, the stability dip, which is found to occur usually at 4~6 weeks after dental implant placement because the decrease of the primary mechanical stability is not compensated by the increase of the secondary biologic stability, is frequently pointed out as one of the major causes of early loading failure. In this article, based on our recent clinical investigation about the crestal bone preservation effect of the early loaded NanoTiteTM Tapered Certain Prevail (Biomet 3i, USA), the concept of the early loading is revisited. In addition, various methods to overcome the stability dip are reviewed as the oral and maxillofacial surgeon’s view point.
Implant-supported restorations were connected to commercially pure titanium endosteal implants 3 months in mandible and 6months in maxilla after the implants were inserted into patient jaws. Modifications of titanium implant surfaces have reduced the waiting time for osseointegration, resulting in the development of the early loading concept, which is defined at present as a restoration in contact with the opposing dentition and placed at least 1 week after implant placement, but no later than 2 months afterward. Nowadays, immediate loading protocols have also been introduced, using the implants that are designed to enhance initial stability. Immediate loading eliminates the edentulous period of a patient. Although dentists widely accept these concepts of early and immediate loading, they agree the conventional loading concept is still necessary, which describes loading protocols later than 2 months after implant insertion. The timing of loading is determined mainly by the factors of a patient. This paper considers for what dental clinicians should be careful in implant-supported restoration procedures, considering the implant late failure.
