Loading Protocols for Partially Edentulous Patients with Extended Edentulous Sites

Focused Question

In partially edentulous patients with extended edentulous sites, what is the effect of immediate implant loading with implant-supported fixed dental prostheses compared to early or conventional loading on implant survival?

Consensus Statements

• Based on limited scientific evidence and under strict selection criteria, immediate implant loading in partially edentulous patients with healed posterior extended edentulous sites presents similar implant survival rates compared to early or conventional loading.
• Insufficient evidence exists to support immediate implant loading in anterior maxillary or mandibular extended edentulous sites.
• Insertion torque, ISQ values, implant length, the need for bone augmentation procedures, the timing of implant placement, smoking, and the presence of parafunctional habits were common criteria in selecting a loading protocol.

In the absence of modifying factors, early loading of solid-screw-type implants with a microtextured surface after 4 to 8 weeks in extended edentulous sites of partially edentulous patients is a predictable treatment approach.

Immediate loading of posterior implants in healed extended edentulous sites seems to be predictable. However, in such cases immediate implant loading is of limited clinical benefit.

Immediate loading of anterior implants in extended edentulous sites of partially edentulous patients should be approached with caution and by experienced clinicians, since insufficient evidence exists to support such treatment.

When immediate implant loading is intended, the following criteria should be considered:

• primary implant stability
• need for substantial bone augmentation
• implant design and dimension
• occlusal factors
• patient habits
• systemic health
• clinician experience.