Complications, risk factors, and failures of immediate functional loading of implants placed in the completely edentulous maxillae: a report of 3 consecutive cases.

PURPOSE: The aim of this article was to document the failure of immediate functional loading of implants placed in 3 consecutive completely edentulous maxillae to analyze the possible causes, risk factors, and how to avoid the complications that occur due to this procedure. MATERIALS AND METHODS: Six implants with standardized length and diameter were placed in 3 consecutive patients with completely edentulous maxillae in the canine, premolar, and molar region bilaterally and flaplessly using computer-guided surgical guides. Screw-retained conversion maxillary prostheses were delivered immediately after the surgery. RESULTS: Patients complained from severe to moderate pain. For the first and second patients (P1 and P2), 4 implants per patient were lost during the second week after implant surgery, whereas 5 implants were lost during the third week after implant surgery for the third patient (P3). CONCLUSION: This high failure rate presented in this report may be explained by 1 or more of the following reasons: poor maxillary bone quality, nonaxial loading of the implants, nonrigid splinting material, high forces delivered from the opposing dentition, and/or patients with para-functional habits.

The effect of two different immediate loading protocols in implant-supported screw-retained prostheses.

BACKGROUND: The aim of this work was to evaluate the changes that occur in the supporting structures of implants placed bilaterally in the posterior mandibular region as a result of 2 different immediate loading protocols: the immediate functional loading protocol and the immediate progressive loading protocol. MATERIALS AND METHODS: Thirty implants were placed in 5 patients with unmodified mandibular Kennedy Class I. For each patient, 3 implants were placed on each side of the patient's dental arch at the premolar/molar mandibular region. At one side, the implants were immediately loaded following an immediate functional loading protocol, whereas the other side was loaded following an immediate progressive loading protocol. Radiographic evaluation was carried out using dental computed tomography at intervals of 0, 4, 9, and 24 months after implant surgery. RESULTS: Statistical analysis showed a more favorable bone reaction with a statistically significant difference in the crestal bone height (P = 0.011) and in the crestal periimplant bone density (P = 0.009) in the immediate progressive loading group than the immediate functional loading group. CONCLUSION: The immediate progressive loading protocol yields a more predictable bone reaction in the periimplant crestal bone and ensures better implant prognosis than the immediate functional loading protocol; supporting the idea that gradual loading or stimulation will allow bone to mature and grow denser in a 2-year implant follow-up period.