Simultaneous immediate loading of maxillary and mandibular Brånemark System ® Implants with a fixed provisional prosthesis in completely edentulous upper and lower jaws: A case report

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Simultaneous immediate loading of maxillary and mandibular Brånemark System ® Implants with a fixed provisional prosthesis in completely edentulous upper and lower jaws: A case report

J. Chow: Simultaneous immediate loading of maxillary and mandibular BrånemarkSystem®Implants with a fixed provisional prosthesis in completely edentulous upper andlower jaws: A case report. Mal. J.Oral Maxillofax. Surg. 2002: 2: 34–41

Introduction and Literature Review Providing immediate function to the dental implant patientsis the ultimate goal in implant dentistry. Clinicians haveattempted different methods to deliver immediate loadingwith various degrees of success1-6. The objective of loadingthe dental implants immediately is to optimize the implanttreatment with respect to patient-centered simplification.The Brånemark System®Novum, which has been recentlyintroduced by Professor Brånemark and coworkers, as a newtreatment concept for completely edentulous mandiblesillustrates this objective very well (Figure 1 and 2)6-7. TheNovum technique combines precision surgery together withengineering using prefabricated titanium surgical andprosthetic components. It allows the clinicians to deliver thedefinitive prostheses to the edentulous mandibular patientson the same day of implant placement. However, theNovum protocol is a non-forgiving procedure, which is verytechnique demanding.Although the Brånemark System®Novum signifies amajor breakthrough in the pursuit of “patient-centeredsimplification”, immediate functional loading of dentalimplants is not a completely new concept. Brånemark andcoworkers have reported their early experience in immediateloading in some patients in 1977 with disappointing results8.They believed that it was very important to allow submergedimplants to heal for an arbitrary period of time withoutpremature loading before the happening of osseointegration.With several decades of research and clinical evidence, wehave learned that primary implant stability is an essentialfactor affecting the successful development ofosseointegration whether the implant is being submerged ornot9-10.In the literature, there are plenty of articles on thesuccessful outcome of immediate loading of the dentalimplants in mandibular cases. However, there is very limiteddata available for maxillary cases.Henry & Rosenberg3used a relined provisionaloverdenture to load the mandibular implants immediatelyin five patients. They reported no failure in their preliminaryreport and concluded “controlled immediate loading ofadequately installed non-submerged implants by reinsertionof a modified denture does not appear to jeopardize theprocess of osseointegration in the anterior mandible”.Schnitman and coworkers1-2reported their protocol ofimmediate loading of the 28 mandibular fixtures in 1990and subsequently published the ten-year results in 1997.According to them, 5-6 fixtures were installed in the inter-foraminal region of the anterior mandible together with 2distal fixtures for each patient. The original denture wasmodified to a temporary fixed bridge that was supported bythe 2 distal fixtures and one anterior fixture. They reportedan 85% implant survival rate after ten years of follow-up.Balshi & Wolfinger4published their preliminary results onimmediate loading of the mandibular fixtures in 10 patients.A minimum of ten fixtures was installed in each patient butonly 4 fixtures were loaded immediately with a fixedtransitional acrylic prosthesis.