Consensus

Immediate Loading vs. Early/Conventional Loading of Immediately Placed Implants in Partially Edentulous Patients from the Patients’ Perspective

Amsterdam 2018

Preamble

The aim of this review was to summarize the scientific evidence on immediate and early/conventional loading of immediately placed implants and to compare them according to the results of patient-reported outcomes of satisfaction, quality of life, and other aspects of treatment. Nine studies were identified and met the selection criteria. However, due to the small number of studies and the heterogeneity of the data, a meta-analysis could not be carried out. Regardless, patient satisfaction ratings were high for both loading strategies, and both resulted in improvement in OHRQoL scores.

Consensus Statements

  • From the patient’s perspective, there is no difference between immediate provisionalization and conventional loading. Both treatment modalities can achieve similar positive patient-reported outcomes.This statement was based on: one RCT and two controlled clinical trials.
  • Based on PROMs, no evidence was found to address early loading of immediately placed implants.This statement was based on the fact that no study was identified reporting on early loading of immediately placed implants.
  • Positive patient-reported outcomes can be achieved following immediate implant placement with immediate provisionalization in a single edentulous space in maxillary anterior and premolar sites. From an occlusion standpoint, most studies reported immediate provisional restoration with no contact in centric occlusion or eccentric movement.This statement was based on: one RCT, two controlled clinical trials and five single cohort studies.
  • The placement of an immediate implant-supported provisional restoration demonstrated a significant improvement in OHIP-14 score.This statement is based on two single cohort studies.
  • From the patient’s perspective, the outcome of immediate implant-supported provisional restorations in contiguous edentulous spaces has yet to be determined.This statement was based on the fact that no study was identified reporting PROMS for contiguous edentulous spaces.
  • Limited evidence is available to support immediate provisionalization based on PROMs.This statement is based on the fact that only a third of the studies used standardized and validated tools to report PROMs.

Clinical Recommendations

  • Based on patients’ perspectives, what loading protocol can be recommended following immediate implant placement in single edentulous spaces? Both immediate provisionalization and conventional loading can be recommended to provide patient benefit. Clinicians’ preferences, expertise, specific case- and patient-related factors should be included to make this determination.This is based on Consensus Statements 1 and 4.
  • When immediate provisionalization of immediately placed implants in single edentulous spaces is chosen, what occlusal scheme should be favoured? Positive patient ratings have been associated with immediate provisional restoration having no contact in centric occlusion and eccentric movements. Therefore, the clinical recommendation is to have no contact in centric occlusion and eccentric movements for immediate implant-supported provisional restorations.This is based on Consensus Statement 3.

References

Publication date: Nov 16, 2018 Last review date: Nov 9, 2018 Next review date: Nov 9, 2021
  • 6th ITI Consensus Conference
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