2 Proceedings of the 4th ITI Consensus Conference: Loading Protocols in Implant Dentistry

2   Proceedings of the 4th ITI Consensus Conference: Loading Protocols in Implant Dentistry

G.O. Gallucci, D. Morton, H.R Weber, D. Wismeijer

Group 3 of the 4th ITI Consensus Conference held in Stuttgart reviewed the current scientific evidence for loading protocols in implant dentistry. The group was composed of three teams:

  • Partially edentulous patients, anterior region

  • Partially edentulous patients, posterior region

  • Edentulous patients

The participants were:

Group leader:     Hans-Peter Weber

Reviewers:          German 0. Gallucci
                                Linda Grütter
                                Mario Roccuzzo

Secretary:           Dean Morton

Co-Reviewers:    Urs Belser
                                Luca Cordaro

Participants:       Gil Alcoforado
                                Juan Blanco
                                Roberto Cornellini
                                Tony Dawson
                                Andreas Feloutzis
                                Siegfried M. Heckmann
                                Frank L. Higginbottom
                                Haldun Iplikçioğlu
                                Bob Jaffin
                                Hong-chang Lai
                                Niklaus P. Lang
                                Richard Leesungbok
                                Robert A. Levine
                                Torsten E. Reichert
                                George K. B. Sándor
                                Makoto Shiota
                                Alejandro Trevino Santos

The group addressing edentulous patients was to present well-structured scientific and clinical evidence related to maxillary and mandibular implant-supported rehabilitations. The specific aim was to assess the survival outcome of various loading protocols according to treatment sequence and selected prosthodontic design.

The electronic search yielded 2,371 publications, of which 61 articles met the inclusion criteria. Only studies reporting on implants with “rough surfaces” were selected for this review. The reported data covered 2,278 patients and 9,701 implants. Studies were grouped according to treatment protocols and prosthodontic designs, and results on conventional, early, and immediate loading were assessed separately for fixed and removable dental prostheses (Table 1).

Although several randomized controlled trials (RCT) and reviews have demonstrated clinical efficiency in shortening the time to loading for edentulous patients, the related scientific evidence is mostly presented from the perspective of implant survival or success, with only limited information about the prosthodontic treatment outcome. To assess the impact of modified loading protocols in edentulous patients accurately, data was analyzed separately for: (1) maxillary and mandibular protocols; (2) fixed and removable rehabilitations; (3) rough-surfaced implants; and (4) implant placement into healed sites or extraction sockets not yet healed. These factors have often been presented as having a direct influence on the implant and prosthodontic survival rate.

Table 1 Number of selected publications by loading protocol and prosthodontic treatment modality.
  Removable Fixed
Maxilla Mandible Maxilla Mandible
(Conventional) loading 3 studies
0 (RCTs)
2 (prospective)
1 (retrospective)
110 pats/530 imps
94.8%-97.7%
OH+
10 studies
4 (RCTs)
4 (prospective)
2 (retrospective)
671 pats/1396 imps
97.1%-100%
OH+
4 studies
1 (RCTs)
3 (prospective)
0 (retrospective)
104 pats/719 imps
95.5%-97.9%
OH+
4 studies
1 (RCTs)
2 (prospective)
1 (retrospective)
207 pats/1254 imps
97.2%-98.7%
OH+
Early loading 2 studies
0 (RCTs)
2 (prospective)
0 (retrospective)
49 pats/185 imps
87.2%-95%
OH-
4 studies
1 (RCTs)
3 (prospective)
0 (retrospective)
68 pats/136 imps
97.1%-100%
OH+
4 studies
1 (RCTs)
1 (prospective)
2 (retrospective)
54 pats/344 imps
93.4%-99%
OH+
3 studies
0 (RCTs)
2 (prospective)
1 (retrospective)
176 pats/802 imps
98.6%-100%
OH+
Immediate loading 1 study
0 (RCTs)
1 (prospective)
0 (retrospective)
12 pats/48 imps
95.6%
OH N/A
7 studies
0 (RCTs)
6 (prospective)
1 (retrospective)
329 pats/1161 imps
96%-100%
OH+
6 studies
0 (RCTs)
5 (prospective)
1 (retrospective)
153 pats/893 imps
95.4%-100%
OH+
7 studies
0 (RCTs)
5 (prospective)
2 (retrospective)
181 pats/942 imps
98%-100%
OH+
Immediate loading of immediately placed implants N/A N/A 4 studies 0 (RCTs)
1 (prospective)
3 (retrospective)
149 pats/1194 imps
87.5%- 98.4%
OH-
2 studies
0 (RCTs)
0 (prospective)
2 (retrospective)
15 pats/97 imps
97.7%-100%
OH+
Total main groups 27 34
Total 61

RCTs: randomized controlled trials, pats: patients, imps: implants, OH: outcome homogeneity, + (less than 10% variation), – (more than 10% variation)

2.1 Recommended Clinical Procedures Regarding Loading Protocols for Endosseous Implants in Edentulous Patients

Several factors have been identified as playing a key role in successfully achieving osseointegration with modified loading protocols: initial implant stability, implant surface characteristics, anatomical conditions, bone metabolism, interim prosthesis design, and occlusion pattern during the healing phase. Ideally, they should be considered in the selection of an appropriate loading protocol for the edentulous patient (see Chapter 5).

According to the 4th ITI Consensus Conference, clinical recommendations for implant loading protocols in different indications were presented using a novel validation protocol (JOMI Supplement, 2009). This validation was based on parameters presented in Table 1. In order to propose clinical recommendations for various loading protocols, study design, sample size, and outcome homogeneity (OH) were considered the fundamental parameters. Outcome homogeneity was considered positive (OH+) when the variation of implant survival rates for the treatment protocol was 10% or less, and negative (OH-) when the variation was greater than 10% (Table 1).

Using these criteria, scientific and/or clinical validati/>

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Jan 7, 2015 | Posted by in Implantology | Comments Off on 2 Proceedings of the 4th ITI Consensus Conference: Loading Protocols in Implant Dentistry
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