Early functional loading at 5 days for Brånemark implants placed into edentulous mandibles: a prospective, open-ended, longitudinal study

Abstract

Background: Traditionally, implants placed in the mandible heal for 3 to 4 months before they are loaded. In maxillae, healing time usually takes 5 to 6 months. The purpose of this study was to evaluate placement of 4 to 6 implants in edentulous mandibles. The implants were placed between mental foramina for support of non-metal, reinforced, fixed, implant-supported provisional prostheses. A unique method was used to convert existing dentures into fixed, implant-supported appliances. The implants were functionally loaded early (5 days).

Methods: Twenty patients with edentulous mandibles or with 2 to 3 remaining mandibular teeth were enrolled in this open-ended, prospective study. Existing dentures without porcelain teeth were modified for use as a surgical guide. These dentures were used as temporary fixed prostheses. Patients were to have metal-reinforced appliances fabricated by the referring dentists after 3 to 4 months of healing. After implant installation, prosthetic abutments were fixed to the implants and tightened to 20 Ncm without counter torque. Bone quality and quantity as well as implant size and position were entered into a computer database. Impression copings were attached to the abutments, and the modified denture was used for a pick-up impression. After the impression was made, implant replicas were fitted to the impression copings and casts were poured. Gold cylinders were processed into the tissue side of the denture. Laboratory screws were used to attach the denture with gold cylinders to abutment replicas. The dentures were processed, polished, and inserted 5 days after implant surgery. Radiographs were taken to verify proper fit of the gold cylinders to the prosthetic abutments (baseline). Radiographs were taken at each follow-up visit and were used to measure changes in crestal bone levels.

Results: Twenty patients received 92 machined-surface commercially pure titanium implants in fully edentulous mandibles. Of the total number of implants placed, two were lost between 0 to 1 year and one between 1 to 2 years. Twenty patients with a total of 90 implants were followed between 0 to 1 year. Fourteen patients have been followed between 1 to 2 years, 7 between 2 to 3 years, and 2 between 3 to 4 years. One patient died after 9 months of loading (4 implants loaded, 2 sleeper implants); another died between 1 to 2 years. A total of 6 implants remained buried (sleepers). At 2 years, the cumulative success rate is 96.3%. Survival of the implant bridges is 100.00%. The mean crestal bone level at 5 days for 11 patients was 2.1 mm (SD 0.526, SE mean 0.159) (measurements were not available for the deceased patient), while the mean level at an average of 15 months was 1.96 mm (SD 0.585, SE mean 0.176). Differences between the measurements taken at 5 days with those taken at an average of 15 months were not significant (P < 0.683).

Conclusions: Results of this study indicate that 4 to 5 implants can be placed and loaded within 5 days of implant insertion with high success (96.3%). Success rates for the interim and final prosthesis are 100%. A simple, possibly cost-effective method of using non-metal reinforced dentures as interim fixed, provisional dentures has been described. Impressions and registrations for making the prosthesis can be made at the time of implant installation, and this method is accurate enough to make provisional restorations. The modified denture can function as an interim fixed, implant-supported prosthesis for up to 30 months. Results of x-ray measurements indicate stable crestal bone levels for up to an average of 15 months.