Loading Protocols for Implant-Supported Overdentures in Edentulous Jaws

Focused Question

In edentulous jaws with implant-supported overdentures, what is the effect of immediate implant loading versus early or conventional loading on implant survival at 1 year?

Consensus Statements

• Current clinical research supports high survival with the use of threaded, microtextured implants with a minimum diameter of 3 mm for the support of overdenture prostheses when used with immediate, early, or conventional loading protocols. Limited evidence exists for immediate loading of implants supporting overdentures in the maxilla.
• Descriptive material from the review in this group for immediate loading by Schimmel et al lists inclusion criteria of: insertion torque (≥ 30 Ncm), ISQ value (≥ 60), two or more implants in the mandible, or four or more implants in the maxilla.
• Splinting of implants and the type of attachment system had no effect on 1-year survival rate compared to freestanding implants.

• The intended loading protocol should be selected considering implant-prosthodontic parameters as well as functional, psychosocial, and financial aspects and patient preference.
• Early loading represents a satisfactory treatment modality in the management of the edentulous jaw, when using implants to support/retain an overdenture prosthesis, and can be recommended as routine in the absence of modifying factors.
• Immediate loading protocols in implant supported/ retained overdentures appear predictable. The available research arbitrarily uses an insertion torque of 30 Ncm or greater and/or an ISQ value of 60 or greater. The evidence for immediate implant loading in the maxilla is less compelling. However, there is no reliable pretreatment predictor that has determined conclusively that the clinician can perform an immediate loading procedure.
• Given the lack of research, the use of a single implant in an immediately loaded fashion may not be indicated for support/retention of overdenture prostheses.