Research Article
Immediate Placement of Dental Implants after Extractions and Immediate Loading of Complete Restorations of the Maxilla, Mandible and Full-Mouth: A Retrospective Consecutive Case Series on 122 Patients and 1042 Implants with up to 8 Year Follow Up Period
Jean-Louis Zadikian1, Jelena Stojanovic1, M. Richard Perez1, Léa Zadikian1, Clémence Zadikian1,
Richard Trushkowsky2*
1Dental Surgeon and Implantologist, Afopi Campus, France
2Department of Cariology and Comprehensive Care, New York University, College of Dentistry, New York, USA
*Corresponding author: Richard Trushkowsky, Department of Cariology and Comprehensive Care, New York University, College of Dentistry, 345 East 24th Street, Clinic 7W, New York, NY 10010, USA
Published: 29 Dec, 2017
Cite this article as: Zadikian J-L, Stojanovic J, Perez MR,
Zadikian L, Zadikian C, Trushkowsky
R. Immediate Placement of Dental
Implants after Extractions and
Immediate Loading of Complete
Restorations of the Maxilla, Mandible
and Full-Mouth: A Retrospective
Consecutive Case Series on 122
Patients and 1042 Implants with up to 8
Year Follow Up Period. Clin Surg. 2017;
2: 1846.
Abstract
Purpose: The aim of this retrospective cases series was to present results of post extraction immediate
implantation and immediate loading at maxilla, mandible and full-mouth with follow-up from 1 to 8
years and to report on survival rate and prosthetic success of a total of 1042 implants.
Material and Methods: This study included 122 patients requiring full-arch maxilla, mandible or
full-mouth prosthetic rehabilitation between June 2006 and September 2012. After the extraction
of hopeless teeth, each patient received in one unique surgical session 6 to 10 implants per arch,
and immediate provisional screw-retained acrylic resin prosthesis. After 4 months at mandible
and 6 months at maxilla (6 months for full-mouth), the provisional screw-retained prosthesis was
removed, and all fixtures were checked for stability. Then all patients received their final screwretained
or cemented prosthesis (produced using CAD-CAM system) with 12 to 14 teeth (for one
arch). There was 28% of screw-retained prosthesis and 72% of cemented prosthesis.
Results: The Cumulative Survival Rate (CSR) reached 98% at the maxilla, 100% at the mandible and
98% when the two arches had implants placed and restored in one unique session. Implant in nondistal
positions had lower risk of failure than those in distal position (HR=0.35, 95% CI: 0.13-0.90).
The rate of prosthetic success remained high during the course of the follow up analysis: 100% at
each end-point for the 3 options (maxilla, mandible, and full-mouth) under analysis.
Conclusion: Combining immediate placement of dental implants after extractions and immediate
loading of complete restorations at the maxilla, the mandible or both is a reliable alternative to more
conservative approaches.
Keywords: Dental implant; Edentulous mandible; Edentulous maxilla; Full arch prosthesis
Introduction
Conventional implant placement procedures achieve predictable and high success rates for an
implant-supported single tooth [1-3]. During the last decade, the 5-year survival rate of implantsupported
prostheses appeared to be significantly increased in more recent as compared to older
studies (from 93.5% to 97.1%) [4]. In the case of implant-supported full-arch fixed dental hybrid
prosthesis, results appear promising for up to a 10 year follow up period (87.89% to 100%), but more
disappointing if a time period longer than 10 years is considered (78.3% to 98.9%) [5]. Consequently,
clinicians recommend avoiding the use of this type of rehabilitation after strategic removal of all the
remaining teeth [5].
However, implants placed in healed sites and remaining unloaded during osseo integration
present some clinical drawbacks. During healing time and osseo integration, the patients have to wear
a removable provisional full arch prosthesis known to be uncomfortable because of the pain caused
on the extraction sockets during the healing process (due to pressure), the size of the prosthesis and the lack of stability. This induces psychological problems by negatively affecting the quality of social, professional and personal
life of these patients. Furthermore, before implant placement, during
the post-extractional healing time a provisional removable prosthesis
contributes to alveolar bone loss particularly with non-grafted
extraction sockets. It is known that 50% of the initial alveolar bone
volume can be lost during the first 12 months and that 65% of the
bone loss occurs during the first 3 months after the extractions took
place [6-9]. Moreover, this classical approach increases the number of
surgical interventions and the total treatment time. A recent review
of Papaspyridakos et al. [10] concluded that when selecting cases
carefully and using dental implants with a rough surface, immediate
loading with fixed prostheses in edentulous patients results in
similar implant and prosthesis survival and failure rates as early and
conventional loading. Therefore, immediately-loaded post-extraction
implantation with a fixed provisional appears to be beneficial in case
of full arch rehabilitation to shorten treatment duration, offer the best
comfort to the patient, preserve alveolar bone volume after extraction
and thus avoid invasive intervention and optimize aesthetic results.
To the best of our knowledge, only a few international publications
reporting from six months to five year follow up are suggesting
that immediate loading of implants at the time of placement is
not deleterious to the clinical outcome [11-14]. Furthermore, we
know of no study that analyzes implant success rates for immediate
placement/immediate loading in full-arch full-mouth restorations,
especially in the long term. Therefore, we have identified a gap in
clinical results related to immediate placement/immediate loading
results on full arch restorations, particularly in: 1) mandible alone,
2) maxilla alone and 3) full-mouth. This retrospective study aims to
help fill this gap by presenting independent results from these three
aforementioned surgical site interventions. The authors developed
procedures consisting in extraction of teeth immediately followed by
implant placement and immediate loading with provisional screwretained
full arch bridges at the maxilla, mandible and at the both
the upper and lower jaws simultaneously (full-mouth). The authors
report on the survival rate and prosthetic success of an immediate
implantation and immediate loading treatment protocol in follow up
cases extending up to 8 years.
Materials and Methods
Patient selection
A consecutive retrospective case series analysis was conducted on
122 patients who were treated from June 2006 to September 2012 at
the Afopi Campus dental clinic (Paris - Sarcelles Village, France). The
selected patients consisted of 69 females and 53 males with an age
range from 34 years to 79 years old. At their initial visit, all patients
presented with a hopeless dentition at mandible or/and maxilla. The
treatment consisted in extractions of the remaining teeth followed
by immediate dental implants placement and immediate loading of
a provisional full arch screw-retained acrylic resin restoration. All
the procedures were conducted by one seasoned operator (Dr. Jean-
Louis Zadikian) who placed a total of 1042 implants. All the relevant
data were recorded after the patients gave their consent and the study
was registered at the CNIL (Commission Nationale Informatique et
Libertés, Paris, France) under the number 1790755V0 assuring the
confidentially of the data compilation and analysis.
Inclusion criteria: The patients treated in this study were
men and women over 18 years old, were partially edentulous and
presented the need for extraction of all or remaining teeth. They
had no contraindications to implantology. Within the frame of a
conventional treatment, they were candidates for a post extraction
removable complete prosthesis. Conventional implant treatment
(with delayed implant placement and delayed restoration) and the
alternative method were proposed to each patient. They all wished to
benefit from the alternative treatment with post-extraction implant
placement, immediate fixed full-arch provisional resin-acrylic
prosthesis and final fixed full arch prosthesis.
Exclusion criteria: Patients fully edentulous wearing a full
removable prosthesis were excluded from the study. Furthermore,
these patients had sufficient bone volume to place at least 6 implantsin
the maxilla and 5 implants in the mandible or a bone volume allowing
the stabilizationand the creation of bone around the implants with
help of a bone substitute and a GBR membrane (BioOss, Biogide,
Geistlich, Switzerland). These patients presented no contraindication
to implantology.
Pre-operative procedure
Clinical examinations and imaging: The examinations consisted
of medical history recording and analysis; clinical intra-oral and
extra-oral examination, panoramic radiographs and Cone beam
Computed Tomography (CT) (Planmeca, Planmeca Oy, Helsinki,
Finland and Vatech, Vatech Fance, Champs sur Marne, France) to
perform the adequate surgical planning.
Planning and initial prosthetic initiation phase: A primary
impression and a secondary impression with a custom impression
tray were taken using alginate. Then a stone model was obtained
and mounted in a dental articulator (FAG Industry et Dentaire –
Quick Master B2). Teeth extraction was anticipated and simulated
on the stone model. Then, a diagnostic wax-up was realized in
centric relation and consequently provided a template for the future
prosthetic restoration considering its volume, contour, occlusion and
implants positioning. The following elements were prepared ahead
of surgery:
- Multi-functional surgical guide (maxillary, mandibular)
- Provisional removal complete resin prosthesis
After assuring the good positioning of the existing removable
prosthesis by visual inspection through a window prepared in the
middle of the acrylic palate, a translucent acrylic resin duplicate was
shaped as a multi-functional surgical guide.
Premedication: All the patients received the same premedication/
medication prescription (Birodogyl 2,5 mUI spiramycin, 250 mg
metronidazole 3 times per dayor Augmentin 3 times 1000 mg per
day, 48 hr prior to the surgery, Célestène 6 mg – MSD FRANCE)
the morning of the intervention, mouth rinse Listerine - long term
use) and were operated under local anesthesia (4% articaine with
1:100.000 adrenalin, Zizine, Paris, France).
All surgeries were performed by a single experienced surgeon
(Dr. Jean-Louis Zadikian).
Surgeries
Maxilla or mandible: The remaining teeth were extracted
atraumatically in a special suite dedicated to surgery of septic tissues.
In order to preserve the bone volume, the extractions were done
atraumatically with conventional or with ultra-sonic (Piezzotome,
Acteon-Satelec, Merignac, France) methods. The removable full
arch prosthesis was placed to confirm occlusal relation and for aesthetic validation purposes. The surgical multi-functional guide
was inserted and occlusion verified. The implantation surgeries were
always performed in an aseptic environment in a dedicated suite.
With the aid of the surgical multifunctional guide, one incision was
realized along the lingual limit corresponding to the lingual aspect
the teeth. This incision allows for raising one single vestibular flap
and maintaining the guide in its accurate position during the surgery
helps to visualize the implant axis. The following implant systems
were used: Speedy Groovy (Nobel Biocare AB, Göteborg Sweden)
or Titamax Ex (Neodent, Curitiba, Brazil) with diameter and length
matching the surgical planning (6 to 10 implant at the maxillary, 5
to 9 at the mandible).In molar area, when the height of bone was
insufficient to place implant, implants were placed tilted. There were
905 Nobel Speedy Groovy implants placed (87%) and 137 Neodent
Titamax implants placed (13%). The frequencies of diameter and
length according to the position are detailed (Tables 1 and 2). At
completion of the drilling sequencethe insertion torques were
recorded directly from the digital screen of the surgical engine (W
and H Implantology Motor, W and H, Bürmoos, Austria). Primary
stability was then assessed based on these maximum insertion
torques. Brånemark System® Mk III or Speedy Groovy (Nobel
Biocare AB, Göteborg Sweden) implants were used with implants
diameter and length-varying depending on location. All the implants
were immediately loaded on the same day taking into account that
they were all linked within the screw-retained provisional bridge.
Implants with external connections were used and immediately after
implant insertion, open-tray transfers were placed and fixed to the
multifunctional surgical guide with Voco Structure resin (Voco,
Cuxhaven, Germany) in order to register the implant positions. The
gap between the buckle bone plate and the implant was systematically
filled up with a bone substitute (Bio-Oss, Geistlich AG, Wolhusen,
Switzerland). The flaps were temporary closed with absorbable
sutures (Vicryl Plus, Ethicon, Cincinnati, OH, USA) without the use
of healing abutments.
Prosthetic protocol: During the same day, after the surgical
procedure, the complete removable prosthesis was transformed into
a provisional screw-retained prosthesis. Then, the screw retained
provisional prosthesis was placed, completing the rehabilitation of
the patients after about 6 hr (in average for one arch) and 8 hr (in
average for two-arches) reaching already improved aesthetic results.
In this retrospective case series, a total of 160 bridges on implants at
maxilla or mandible (including full arch and full-mouth treatment)
were immediately loaded. The patients were instructed on hygiene
maintenance methods, and a soft diet was recommended up to 3
months after surgery. The absorb able sutures were placed. In case of
full-mouth treatment patients benefited from a full rehabilitation of
both maxilla and mandible at the same time.
Follow up
Patients were examined clinically after one week, two weeks.
Radiographs and CT were taken at 3months for mandibular and
six months for maxillary and full-mouth cases. The patients were
followed at 6 and 12 months and thereafter, yearly. The mean followup
time was 4.1 years with a standard deviation of 1.8. The maximum
follow-up was 8 years and the minimum 1 year. The study covered
504 person-years. For every patient yearly follow-up visit, a clinical
examination, a panoramic X-ray and a CBCT were performed. If
a patient exhibited bleeding around an implant associated with
an image showing a bone defect then the prosthesis was removed
(whatever the type of prosthesis, screwed or cemented), and the
implants were checked. Implant mobility was evaluated manually.
During the study, 16 implants resulted in failure and were lost before
the final prosthesis. During all the period following the placement of
the final prosthesis, no loss of implant was observed. Table 3 detailed the number of implants by follow-up time.
Final prosthesis
After 4 months at mandible and 6 months at maxilla (6 months for
full-mouth), the provisional screw-retained prosthesis was removed,
and all fixtures were checked for stability. Then all patients received
their final screw-retained or cemented prosthesis (produced using
CAD-CAM system) with 12 to 14 teeth (for one arch). There was 28%
of screw-retained prosthesis and 72% of cemented prosthesis and
the number of implant supporting each prosthesis was as detailed in
(Table 4).
Data collection and statistical analysis
The data recording on the standardized case documentation
form was electronically given by a skilled assistant. A double check
for consistency was conducted by another individual. Data were
retrospectively collected from the case documentation data bank.
An implant was considered as a failure if it was removed because of
mobility, loss of integration, on-going bone loss, infection, persistent
pain or patient discomfort. A “successful prosthesis” is a prosthetic
reconstruction that is stable and fulfills the patient expectation with
respect to function and aesthetic. Descriptive statistical analysis
depicted mean, standard deviation or frequency distribution
depending on the nature of the parameters. Respectively, the Chisquared
test or the Kruskal-Wallis tests were used for the comparison
of groups. Survival analyses were performed using the Kaplan-Meier
method and the log rank test was used for the comparison between
groups. Cox proportional hazard models were used to determine the
association of implant failure and different risk factors. The effect of
the factor patient was included in the models as a random effect. All
performed tests were two-tailed and the considered alpha level was 0.05. SAS version 9 (SAS Institute Inc, Cary, NC, USA) was used for
the statistical analysis.
Table 1
Table 2
Table 3
Table 4
Table 5
Table 6
Table 7
Results
The probabilities of survival for all implants depend on several
risk factors (arch type, extraction, position and inclination of an
implant) are shown in (Table 5). Although the risks of implant type
was higher for maxilla compared to full-mouth and of healed versus
extraction, they were not statistically significant (Table 5). The risk of
an implant failure in a non-distal position was statistically significant
lower for implants in non-distal positions than those in a distal
position (hazard ratio=0.35, 95% CI: 0.13-0.90, p=0.030). Implant
failure was similar for straight/inclined implants in distal positions.
Maxillary
61 patients, 37 women and 24 men benefited from the surgical
and prosthetic treatments. 430 teeth were extracted with an average
of 7.0 per patient (ranging from 1 to 15). A total of 441 implants were
placed in the maxilla, the survival rate at the end of the study reached
98% (Table 6). 266 implants were placed in extraction sockets and
175 in healed sites. The risk of implant failure was higher but nonstatistically
significant in extracted than in healed sockets (Table 7).
Each patient received 6 to 10 implants per maxilla. Implants placed
in the most distal position had a much lower risk of failure than those
implanted in a distal position (HR=0.18; 95% CI:0.05-0.72; p=0.015).
If only distal implants are considered, the failure risk of straight
implants was a bit lower than those of tilted implants (Table 7).
Mandible
32 patients, 21 women and 11 men were treated. 233 teeth were
extracted with an average of 7.3 per patient (ranging from 2 to 15).
A total of 206 implants were inserted. 127 implants were inserted in
extraction sockets and 79 in healed sites. The implant survival rate in
the mandible was 100% (Table 6), therefore respective survival rates
by all other implant characteristics was 100%. Each patient received 5
to 9 implants. Out of 64 implants in distal position, 39 straight and 25
angulated. Full mouth 29 patients, 11 women, and 18 men had in total
459 teeth extracted with an average of 15.8 per patient (ranging from
5 to 25). A total of 395 implants were placed, 240 in extraction sockets
and 155 in healed sites. The overall implant survival rate was 98%
(Table 6). The risk of implant failure for implants place in non-distal
positions was lower, although not statistically significant, than those
placed in a distal position (HR=0.68; 95% CI:0.16-2.84; p=0.595. If
only distal implants are considered, straight implants showed higher
implant failure than tilted implants (Table 7).
Prosthetic success
The prosthetic success was assessed in regard of the number of
cases where we were not able to place a fixed provisional prosthesis of a
fixed definitive prosthesis. If a patient received a removable prosthesis
during the treatment it was counted as a prosthetic failure. The rate of
prosthetic success remained high during the course of the follow up
analysis: 100% at each end-point for the 3 options (maxilla, mandible,
and full-mouth) under analysis. The level of patient satisfaction was
very high and particularly related to avoiding the transition period
with removable denture between surgery and final screw-retained
restoration.
Discussion
The primary function of a dental implant is to support a prosthetic
system (abutment and restoration), in a similar way as natural tooth
root with a crown. Any success criteria, therefore, must consider
the foremost support of a functional prosthesis. In addition, high
patient satisfaction related to function and aesthetic appearance of
the rehabilitation is required. In the present retrospective consecutive
clinical report, the prosthetic success rate and the patient satisfaction level were assessed at each end point. By reference to the combination
of criteria proposed by Papaspyridakos et al. [15]. (Success at the
prosthetic level during a five-year period) and patient satisfaction the
results of the present study are very high after short and long periods of
time. It must be taken into consideration that evaluations of aesthetic
results refer mostly to implant rehabilitation in the maxillary anterior
zone and that there are yet no universally accepted evaluation criteria
of the aesthetic result [16]. Immediate functional loading is a new
surgical-prosthetic technique that can be used extensively in implant
placement. The improvement of clinical protocols, the attention to
biological principles, modification in implant design and surfaces has
resulted in increased utilization and predictability of this procedure
[17]. However, there are a large number of parameters to be taken
into account in the proposed “one-step” surgical procedure that
could affect the clinical outcome: extraction socket vs. healed site
implant placement, single teeth replacement vs. single jaw full arch
replacement and/or bimaxillary full arch replacement, as well as
the effect of immediate loading [12]. The overall implant survival
rate after 6 months was 99.1%. Five lost implants were inserted in
fresh extraction sockets (1.4%) and one in a healed site (0.3%). In
our study the failure rate was 1.9% of implants lost when placed in
fresh extraction sites vs. 2.3% when inserted in healed sites Similar to
Gillot et al. [12]. The statistical analysis did not depict any significant
differences between implant placed on healed site or in extraction
socket. In our own case series, no differences were shown whether
the implants were placed in an extraction socket or in a healed site
whatever jaw was treated (maxilla alone, mandible alone, the both
simultaneously) [18]. Conducted a systematic review of the literature
and a meta-analysis of 10 controlled randomized trials on the
annual failure rates and marginal bone-level changes of immediate
compared to conventional loading of dental implants. They did not
found any clinically relevant differences regarding annual failure
rates or radiographic bone-level changes between conventionally and
immediately loaded implants for up to 5 years of follow-up.
Maxillary full-arch treatment
While our study reports on implants placed on healed site and
in extraction socket with immediate loading, the reached CSR (98%)
is equivalent to those reported by Degidi et al. [19]. Who dealt only
with fully edentulous patient. In addition, we show that there are no
significant differences of CSR between implant placed on healed site
or in extraction socket. We can draw the conclusion that immediate
functional loading is a reliable surgical-prosthetic procedure in
maxillae rehabilitation on fully edentulous patient. We confirm
the study of Gillot et al. [12]. Where only short terms follow up is
considered (inferior to 1 year). Immediate implant placement and
loading resulted in high implant as well as high prosthetic survival
rates (98% implant survival in the present study). With longer term
observation periods the results become equivalent to those obtained
by Balshi et al. [20,21]. Who reached a CSR of 96.3% (after 6 years).
At the two observational periods and in the 3 above studies the
prosthetic survival remained very close to 100% as in the present
study. As shown in the above reported studies the full-arch maxillary
implant insertions and immediately loaded provisional prostheses
provides a lasting state of osseo integration as the foundation for
long-term stability of fixed prostheses. By comparing immediate and
conventional loading Peñarrocha-Oltra et al. [22] an implant success
rates of 96.8% and 99.0% respectively after 12 months. The success
rate of the immediately loaded prostheses was 100%. In the immediate
loading group, the most common complications were screw loosening
and tooth fractures; in the control group, dentures caused discomfort
and soft tissue irritation. We indicated this drawback in the present
paper as common in daily practice. The above reported studies all
concluded high success rates after implantation in the maxilla as
confirmed by our study.
|Mandibular full-arch treatment
In general rehabilitations in the mandible are less documented
[21]. Reached a CSR of 97.8% (after 6 years), to be compared to the
100% obtained in our study. The prosthesis survival was in both
studies close to 100%.
Studied 12 mandibles, 5 maxillary, including 3 bi-maxillary
patients [11]. The results suggested that immediate loading of
implants at the time of placement added a valuable predictability to the
treatments for both mandibular and maxillary arches [23]. Published
a systematic review referring to 46 prospective studies, with a mean
follow-up time of 2.08 years. The annual failure rate of immediate
implants was 0.82% translating into the 2-year survival rate of 98.4%.
Lower failure rates were found in groups that were provided with a
course of post-operative antibiotics. This information can potentially
apply to the present study in which patients benefited from antibiotic
treatment before and after the implantation surgery. The number of
cases reported in the present study allow for a comparative statistical
analysis between full-arch treatments at the mandible and maxilla.
With respect to CSR a significant difference exists between mandible
and maxilla. In single tooth restoration, it is well known that implant
placement success rates are typically higher in the mandible than in
the maxilla. Interestingly, this same trend appears valid for full-arch
restorations, with a slightly higher failure rate noted in the maxilla
(albeit not statistically different).
Full-mouth treatment
Conducted a survey on 659 immediate post-extraction implants
obtained from a bibliographic review of 25 articles [24]. 322 patients
have been treated with a total of 659 implants placed immediately
following extraction. A total of 441 implants were inserted in the
maxilla, 152 in the mandible and 64 were placed in an unspecified
location. The survival rate ranged between 85% and 100%. Although
these results are interesting the problem of implants contributing to
full arch restoration was not addressed [11]. Is the only one reporting
on full-mouth treatment on a limited number of 3 cases. During an 8
to 24-month follow-up period, the survival rate was 97.2%. This result
is to be compared with the much longer follow up periods reported in
our study the CSR appeared to be stabilized at 97.97% and for a much
larger number of cases (29). Our consecutive observational study
is the much larger conducted so far on maxillary, mandibular and
bimaxillary reconstruction (121 patients, 1042 implants) over a long
time period. The average follow up period of 5 years allows for drawing
substantial surgical and clinical conclusions. The CSR is slightly less
at the maxilla (97.7%) than at the mandible (100%) and full-mouth
approach exhibited results of 97.97%. We observed a similar CSR for
full-arch maxillary rehabilitation and full-mouth rehabilitation. The
same absence of difference has been found between maxillary full-arch
rehabilitation and full-mouth rehabilitation. It could be hypothesized
that preserving both the bone structure and gingival architecture, as
well as providing immediate functional loading is positive.
Single tooth vs. multiple teeth
We agree with Sanz-Sanchez et al. [25]. That single teeth implants
show greater risk of failure, when compared to immediately load full arch restorations. This study reinforces our choice to load the implants
because the screw-retained prostheses maintain the implants together
and increase their stability. It is assumed that the provisional screwretained
prosthesis maintains the implants together and secures the
implants inserted with a low torque value (10-20 Ncm), even though
the vast majority of the implants in this study had a higher insertion
torque than 30 Ncm. If we consider only the implants that were
inserted with a “low” insertion torque(less than 30 Ncm), the success
rate results of these implants support the idea that the provisional
screw-retained prosthesis indeed maintain some kind of increased
stability over time.
Distal vs. non-distal implants
Shows that 97.81% of tilted implants and 98.11% of axial implants
were osseo integrated [26]. (Meta-analysis on 11 articles with 1623
implants - 63 straight and 60 angulated). We report a slightly lower
success rate for angled implants as compared to straight-placed
implants but it has to be noticed that in the present study, angled
implants were systematically placed in the distal position. While
distally placed implants can also be straight, the success rate between
distal and angled distal implants was found to be equivalent.
Conclusion
In the present observational study, the prosthetic success and patient satisfaction was very high. This is likely to be related to the initial clinical stand point of these patients whose dental health is very severely compromised. As they suffered during years of a very poor oral health they indubitably felt improvement. Combining immediate placement of dental implants after extractions and immediate loading of complete restorations at the maxilla, the mandible or both is a reliable alternative demonstrating a Cumulative Survival Rate (CSR) similar to that of more conventional techniques. The high Cumulative Survival Rates (CSRs) demonstrate that the above described treatments are a viable alternative for rehabilitating the edentulous maxilla or mandible or the both jaws at the same time.
Conclusion
Concerning the approval from an Institutional Review Board (IRB) or an Ethics Review Committee (ERC). This study is a retrospective study based on treatment performed on regular basis in his private practice and as we write it in the manuscript: "All the relevant data were recorded after the patients gave their consent and the study was registered at the CNIL (Commission Nationale Informatique et Libertés, Paris, France) under the number 1790755V0 assuring the confidentially of the data compilation and analysis."
References
- Brånemark PI. Osseointegration and its experimental background. J Prosthet Dent. 1983;50(3):399-410.
- Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1(1):11-25.
- Jung RE, Pjetursson BE, Glauser R, Zembic A, Zwahlen M, Lang NP. A systematic review of the 5-year survival and complication rates of implant-supported single crowns. Clin Oral Implants Res. 2008;19(2):119-30.
- Pjetursson BE, Asgeirsson AG, Zwahlen M, Sailer I. Improvements in implant dentistry over the last decade: comparison of survival and complication rates in older and newer publications. Int J Oral Maxillofac Implants. 2014;29:308-24.
- Kwon T, Bain PA, Levin L. Systematic review of short- (5-10 years) and long-term (10 years or more) survival and success of full-arch fixed dental hybrid prostheses and supporting implants. J Dent. 2014;42(10):1228-41.
- Schropp L, Wenzel A, Kostopoulos L, Karring T. Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent. 2003;23(4):313-23.
- Araújo MG, Lindhe J. Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol. 2005;32(2):212-8.
- Pietrokovski J, Starinsky R, Arensburg B, Kaffe I. Morphologic characteristics of bony edentulous jaws. J Prosthodont. 2007;16(2):141-7.
- Tandlich M, Ekstein J, Reisman P, Shapira L. Removable prostheses may enhance marginal bone loss around dental implants: a long-term retrospective analysis. J Periodontol. 2007;78(12):2253-9.
- 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.
- Horiuchi K, Uchida H, Yamamoto K, Sugimura M. Immediate loading of Brånemark system implants following placement in edentulous patients: a clinical report. Int J Oral Maxillofac Implants. 2000;15(6):824-30.
- Gillot L, Cannas B, Buti J, Noharet R. A retrospective cohort study of 113 patients rehabilitated with immediately loaded maxillary cross arch fixed dental prostheses in combination with immediate implant placement. Eur J Oral Implantol. 2012;5(1):71-9.
- Maló P, Nobre Md, Lopes A. The rehabilitation of completely edentulous maxillae with different degrees of resorption with four or more immediately loaded implants: a 5-year retrospective study and a new classification. Eur J Oral Implantol. 2011;4(3):227-43.
- Maló P, de Araújo Nobre M, Lopes A, Francischone C, Rigolizzo M. "All-on-4" immediate-function concept for completely edentulous maxillae: a clinical report on the medium (3 years) and long-term (5 years) outcomes. Clin Implant Dent Relat Res. 2012;14 Suppl 1:e139-50.
- 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.
- Annibali S, Bignozzi I, La Monaca G, Cristalli MP. Usefulness of the aesthetic result as a success criterion for implant therapy: a review. Clin Implant Dent Relat Res. 2012;14(1):3-40.
- Del Fabbro M, Testori T, Francetti L, Taschieri S, Weinstein R. Systematic review of survival rates for immediately loaded dental implants. Int J Periodontics Restorative Dent. 2006;26(3):249-63.
- Engelhardt S, Papacosta P, Rathe F, Özen J, Jansen JA, Junker R. Annual failure rates and marginal bone-level changes of immediate compared to conventional loading of dental implants. A systematic review of the literature and meta-analysis. Clin Oral Implants Res. 2015;26(6):671-87.
- Degidi M, Piattelli A, Felice P, Carinci F. Immediate functional loading of edentulous maxilla: a 5-year retrospective study of 388 titanium implants. J Periodontol. 2005;76(6):1016-24.
- Balshi SF, Wolfinger GJ, Balshi TJ. A prospective study of immediate functional loading, following the Teeth in a Day protocol: a case series of 55 consecutive edentulous maxillas. Clin Implant Dent Relat Res. 2005;7(1):24-31.
- Balshi TJ, Wolfinger GJ, Slauch RW, Balshi SF. A Retrospective Analysis of 800 Brånemark System Implants Following the All-on-Four™ Protocol. J Prosthodont. 2014;23(2):83-8.
- Peñarrocha-Oltra D, Covani U, Aparicio A, Ata-Ali J, Peñarrocha-Diago M, Peñarrocha-Diago M. Immediate versus conventional loading for the maxilla with implants placed into fresh and healed extraction sites to support a full-arch fixed prosthesis: nonrandomized controlled clinical study. Int J Oral Maxillofac Implants. 2013;28(4):1116-24.
- Lang NP, Pun L, Lau KY, Li KY, Wong MC. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Clin Oral Implants Res. 2012;23 Suppl 5:39-66.
- Enríquez-Sacristán C, Barona-Dorado C, Calvo-Guirado JL, Leco-Berrocal I, Martínez-González JM. Immediate post-extraction implants subject to immediate loading: a meta-analytic study. Med Oral Patol Oral Cir Bucal. 2011;16(7):e919-24.
- 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.
- Menini M, Signori A, Tealdo T, Bevilacqua M, Pera F, Ravera G, et al. Tilted implants in the immediate loading rehabilitation of the maxilla: a systematic review. J Dent Res. 2012;91(9):821-7.