Loading Protocols for Fixed Prostheses in Edentulous Jaws

Focused Question

In edentulous patients, what is the effect of immediate implant loading with fixed prostheses compared to early and conventional loading on implant and prosthesis survival?

Consensus Statements

• The existing literature provides high evidence that immediate loading of microtextured dental implants with one-piece fixed interim prostheses in both the edentulous mandible and maxilla is as predictable as early and conventional loading.
• Inclusion criteria, such as insertion torque ≥ 30 Ncm, ISQ ≥ 60, and minimal implant length ≥ 10 mm, have been used in the majority of the included studies.
• The number of implants used to support a fixed prosthesis varied from 2 to 10 in the mandible and 4 to 12 in the maxilla.

• The treatment of edentulism with fixed implant supported prostheses is complex according to the ITI SAC criteria. Therefore, careful case selection and treatment planning, as well as adequate knowledge, skill, and experience of the clinician(s) performing the procedures are key. Immediate, early, or conventional loading with one-piece fixed interim prostheses have demonstrated high implant and prosthesis survival rates and can be recommended for the mandible and maxilla.
• Patient-centered benefits of immediate loading include the immediate fixed restoration of function, the reduction of postoperative discomfort caused by a removable interim prosthesis, as well as the reduction of overall treatment time.
• The number, size, and distribution of implants for a full-arch fixed prosthesis needs to be based on the implant-prosthodontic plan, arch form, and bone volume, regardless of the loading protocol.
• Primary implant stability is critical for predictable osseointegration regardless of the loading protocol. It is suggested that prior to immediate loading in the edentulous arch, the primary stability of each implant must be confirmed.
• The need for simultaneous procedures such as bone augmentation or sinus floor elevation is considered a relative contraindication for immediate loading.