Early failures of immediate loaded mandibular implants vs. implants placed according traditional protocol Implantes insertados/fallados Autores Convencionales______% Fallas__ Balshi y Wolfinger 1997 (60) 90/2 2.2% Schnitman y col. 1997 (233) 35/0 0% Tarnow y col. 1997 (232) *
Carga Inmediata
% Fallas
40/8
20%
28/3
10.7%
20/2
10%
Etapas
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Immediate Loading Loma Linda protocol
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Immediate Loading Loma Linda protocol
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Immediate Loading Loma Linda Protocol SURGERY
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Immediate Loading Loma Linda Protocol SURGERY
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Immediate Loading Loma Linda Protocol SURGERY
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Immediate Loading Loma Linda Protocol SURGERY
6 MONTHS
12 MONTHS
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Immediate Loading Loma Linda Protocol Milled Bar SURGERY
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Immediate Loading Loma Linda Protocol Milled Bar SURGERY
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Immediate Loading Fixed Complete Denture
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Immediate Loading Fixed Complete Denture
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Patient Selection Type I / II Bone Anterior Mandible Good patient compliance
Proposed Guidelines for Immediately Loaded Implants Dr. Jaime L. Lozada Loma Linda University Patient
Implant Selection HA / TPS Threaded Implants Adequate bone quantity and quality to permit use of 14-18mm long implants. Immediate Splinting with definitive prosthesis within 24 hrs.
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Immediate loading of a single hydroxyapatitecoated threaded root form implant: a clinical report. Gomes-A; LozadaJL; Caplanis-N; Kleinman-A J Oral Implantol. 1998; 24(3): 159-166
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Gomes-A; Lozada-JL; Caplanis-N; Kleinman-A J Oral Implantol.1998; 24(3): 159-166
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Gomes-A; Lozada-JL; Caplanis-N; Kleinman-A J Oral Implantol. 1998 24(3): 159-166
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Gomes-A; Lozada-JL; Caplanis-N; Kleinman-A J Oral Implantol. 1998 24(3): 159-166
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Gomes-A; Lozada-JL; Caplanis-N; Kleinman-A J Oral Implantol. 1998 24(3): 159-166
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Gomes-A; Lozada-JL; Caplanis-N; Kleinman-A J Oral Implantol. 1998 24(3): 159-166
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Gomes-A; Lozada-JL; Caplanis-N; Kleinman-A J Oral Implantol. 1998 24(3): 159-166
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Gomes-A; Lozada-JL; Caplanis-N; Kleinman-A J Oral Implantol.1998; 24(3): 159-166
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Gomes-A; Lozada-JL; Caplanis-N; Kleinman-A J Oral Implantol.1998; 24(3): 159-166
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1-YEAR RECALL Gomes-A; Lozada-JL; Caplanis-N; Kleinman-A J Oral Implantol.1998;
24(3): 159-166
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1-YEAR RECALL Immediate Loading IJOMI, Vol.17, 4, 2002: 567572
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Effects of Immediate Loading with Threaded HACoated Root-Form Implants on Single Premolar Replacements: A Prelimenary Report
1-YEAR RECALL
P. Proussaefs, J. Kan, J. Lozada A.Kleinman, A. Farnos
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Immediate Placement and Loading
1-YEAR RECALL
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Immediate Placement and Loading 10-months postop
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Single-Tooth Replacement 1-YEAR RECALL in the Aesthetic Zone with Immediate Immediate Placement Provisionalization: Fourteen Consecutive Case Reports and Loading Peter S.
Whoerle Pract Periodont Aesthet Dent
This initial investigation explored the feasibility of placing and provisionally restoring endosseous implants at the time of tooth extraction in order to predictably maintain the soft and hard tissue arquitecture in the aesthetic zone, maintain the harmonious appearance of the tissues, and increase patient acceptance
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Immediate Placement and Loading
1-YEAR RECALL
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Immediate Placement and Loading
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Restorative Approach: Provisional and SoftTissue Management
3 mm.
Immediate Placement and Loading
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Stage 1 placement through Stage 2 uncovering
The Influence of Bone Thickness on Facial Marginal 3061 implants Bone
Spray R, Black C. et al
As facial bone thickness approached 1,82mm.
Ann Periodontal 2000; 5:119- bone loss decreased significantly 128 “Critical thickness value” 2mm, of facial bone
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The effect of the interimplant distance on the height of inter-implant bone crest. Tarnow D-P, et al, J Periodontol 2000 Apr;71(4):546-9
Restorative Approach:Implants with a distance of 3 mm or grater between them had a Provisional crestal bone loss 0.45 mm Implants with a distance of 3 mm or less between them had a crestal bone loss of 1.04 mm
Immediate Placement and Loading
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Immediate Placement and Loading
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Immediate Placement and Loading
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Immediate Placement and Loading
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Immediate Placement and Loading
QuickTime™ and a H.263 decompressor are needed to see this picture.
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IMMEDIATE LOADING Sociedad Espanola de Implantes World Congress, Barcelona. 2002 Aparicio,Rangert, Sennerby
TDOCUMENTATION OF DIFFERENT INDICATIONS
Immediata/early loading of full-arch mandibular
fixed prostheses and overdentures supported by implants placed in healed sites are accepted clinical procedures with adequate documentation
Immediate/early nonocclusal loading of single-
tooth replacements and short-span bridges in the esthetic zones may be accepted clinical procedures with further research
Immediate/early occlusa/nonocclusa loading in other regionsl are still under development
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IMMEDIATE LOADING Sociedad Espanola de Implantes World Congress, Barcelona. 2002 Aparicio,Rangert, Sennerby
CONSIDERATIONS FOR IMMEDIATE/EARLY IMPLANT LOADING
Adequate initial implant stability is considered important for a successful outcome Controlled occlusal loads for full-arch cases and nonocclusal for short-span bridges and single-tooth replacements are considered important for a successful outcome Site evaluation for bone density/volumen and controlled infection and inflammation are considered important for a successful outcome
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IMMEDIATE LOADING Sociedad Espanola de Implantes World Congress, Barcelona. 2002 Aparicio,Rangert, Sennerby
STABILITY ENHANCEMENT AT IMMEDIATE/EARLY LOADING
ďƒź Implant surface modifications might be beneficialin soft bone qualities and extraction sites for maintaining implant stability during the early healing period, but further research is needed
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IMMEDIATE LOADING Sociedad Espanola de Implantes World Congress, Barcelona. 2002 Aparicio,Rangert, Sennerby
IMPLANT PLACEMENT IN FRESH EXTRACTION SITES WITH IMMEDIATE/EARLY LOADING
When the drill diameter is larger than the socket, the situation is similar to that of a healed site Discrepancies between implant dimension and the osteotomy must be reconciled In the case of actve periodontal/periapical disease, there is a risk for an increased inflammatory response, which may jeopardize the osseointegration Placement of implants in fresh extraction sites is possible, but elucidation of risk factors is necessary
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IMMEDIATE LOADING
IMPLANT PLACEMENT IN FRESH EXTRACTION SITES WITH IMMEDIATE/EARLY LOADING
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IMMEDIATE LOADING
IMPLANT PLACEMENT IN FRESH EXTRACTION SITES WITH IMMEDIATE/EARLY LOADING
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IMMEDIATE LOADING Sociedad Espanola de Implantes World Congress, Barcelona. 2002 Aparicio,Rangert, Sennerby
TREATMENT PLANNING AT IMMEDIATE/EARLY LOADING
Ensure sufficient number and spread of implants Ensure stable adjacent teeth Minimize or reduce occlusal tables Use rigid splinting whenever possible Maximize the spread and distribution of contacts It is important to recheck the occlusion during the first days and weeks after immediate/early loading Use the best positions for the permanent implants, and place any provisional or reserve implants in the leftover sites
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IMMEDIATE LOADING Sociedad Espanola de Implantes World Congress, Barcelona. 2002 Aparicio,Rangert, Sennerby
DIAGNOSTIC TOOLS FOR IMMEDIATE/EARLY LOADING
PrimarySstability Measurment Resonance frequency analysis: (RFA) gives objective measurments of initial implant stability. However, there are insufficient data at this time to provide definitive values of what are safe initial stability measurments Insertion torque values :A value between 30 and 50 Ncm before the implant is fully seated appears to provide required stability
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IMMEDIATE LOADING Critical review of immediate implant loading
R. Gapski et al. Clin. Orasl Impl. Res, 14, 2003;515-527
Factors that may influence the results of immediate loading Surgery Host-related healing
factors Implant- related factors Occlusion-related
factors
Primary stability - Surgical technique Bone quality & quantity - Wound Implant design - Implant surface Implant length
Quality & quantity of forces -
Prosthetic design
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