This document discusses a study that tested the stability of immediately loading dental implants in the anterior mandible to support over dentures. 10 patients received implants using a modified loading protocol, with impregum material replacing plastic retention components. Of the 28 implants placed, 1 failed, yielding a 96.4% success rate. Minimal bone loss was observed. The results support immediate loading of anterior mandibular implants for over dentures as a viable treatment option.

1. Immediate loading of implantImmediate loading of implant
over dentures using modified loadingover dentures using modified loading
protocolprotocol
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing Dental EducationLeader in continuing Dental Education
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2. introductionintroduction
• Evolution of implantlogyEvolution of implantlogy
• Development period , exploration period and refinementDevelopment period , exploration period and refinement
periodperiod
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3. AimAim
• To check stability of implant under immediate loading ofTo check stability of implant under immediate loading of
implant over dentures using modified loading protocolimplant over dentures using modified loading protocol
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4. Material and methodsMaterial and methods
• Total of 10Total of 10 patients with mean age of 68patients with mean age of 68
• 6 patients completely edentulous and 4 patients partial6 patients completely edentulous and 4 patients partial
edentulous in maxilla with Rpd and completelyedentulous in maxilla with Rpd and completely
edentulous in mandibleedentulous in mandible
• Implants used were Zimmer dental , tapered screw ventImplants used were Zimmer dental , tapered screw vent
13x3.75mm or Advent 13x4.7mm13x3.75mm or Advent 13x4.7mm
• All patients had ridges of adequate size , no systemicAll patients had ridges of adequate size , no systemicwww.indiandentalacademy.comwww.indiandentalacademy.com

5. • Before surgery impressions of arch were madeBefore surgery impressions of arch were made
• Models were mounted in an articulator using face bowModels were mounted in an articulator using face bow
and bite registration on occlusal rims for establishingand bite registration on occlusal rims for establishing
centric relationcentric relation
• Teeth arrangement were made and patient approval wasTeeth arrangement were made and patient approval was
taken, processed .taken, processed .
• Teeth arrangement data were also duplicated into clearTeeth arrangement data were also duplicated into clear
acrylic apparatus to be used as surgical template toacrylic apparatus to be used as surgical template to
ensure that implants were placed in an appropriateensure that implants were placed in an appropriate
bucco- lingual position to allow for retro fitting of denturebucco- lingual position to allow for retro fitting of denture
on to the implantson to the implants
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6. • Using template 3 implantsUsing template 3 implants placed in anterior mandibleplaced in anterior mandible
• Only 2 of 3 implants were loadedOnly 2 of 3 implants were loaded
• Third implant was kept as a back upThird implant was kept as a back up
• Immd after surgery over denture was connected toImmd after surgery over denture was connected to
implants after 2 ball attachments were placed on theimplants after 2 ball attachments were placed on the
distal implantsdistal implants
• Checked to ensure the fit of denture on to implantsChecked to ensure the fit of denture on to implants
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7. • Appropriate area of denture was hollowed ,metalAppropriate area of denture was hollowed ,metal
housings attached to denture with cold cure acrylichousings attached to denture with cold cure acrylic
• Plastic apparatus for retention was not placedPlastic apparatus for retention was not placed
• Instead housings were filled with impregum impressionInstead housings were filled with impregum impression
material- resilient, rubbery textured, replaced everymaterial- resilient, rubbery textured, replaced every
2weeks for 3 months following surgery2weeks for 3 months following surgery
• Patients were evaluated every 2weeks to check tissue,Patients were evaluated every 2weeks to check tissue,
implant and impregumimplant and impregum
• In addition insrtucted to chew soft food for 3monthsIn addition insrtucted to chew soft food for 3months
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8. • After 3months plastic appratus was connectedAfter 3months plastic appratus was connected
• Panoramic x rays were taken after surgery, 6months ofPanoramic x rays were taken after surgery, 6months of
loading , 1year and every yearloading , 1year and every year
• Bone support was measured from implant and crestalBone support was measured from implant and crestal
bonebone
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9. ResultsResults
• Of 28 implants placedOf 28 implants placed only 1 failedonly 1 failed
• Failure occurred in a patient wit 12 month follow up andFailure occurred in a patient wit 12 month follow up and
two other had no complicationstwo other had no complications
• Other patients with follow up visits ranging from 18(2Other patients with follow up visits ranging from 18(2
patients), 24(4patients), and 30 months (1patient) had nopatients), 24(4patients), and 30 months (1patient) had no
complications except one patient with follow up of 30complications except one patient with follow up of 30
months with 1mm bone lossmonths with 1mm bone loss
• The 1 failed implant for total implants placed representsThe 1 failed implant for total implants placed represents
success rate of 96.4%success rate of 96.4%
• Minimal bone loss 1mm in 2 sites represents successMinimal bone loss 1mm in 2 sites represents success
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10. • No/ type of implant location complications bone loss follow upNo/ type of implant location complications bone loss follow up
• 3-TSVB 27, 24, 22 NONE NONE 243-TSVB 27, 24, 22 NONE NONE 24
• 3-TSVB 27 26 23 NONE NONE 243-TSVB 27 26 23 NONE NONE 24
• 2-TSVB 26,23 NONE NONE 242-TSVB 26,23 NONE NONE 24
• 3-ADVENT 27, 26,23 NONE NONE 123-ADVENT 27, 26,23 NONE NONE 12
• 3-TSVB 27, 26,23 26 FAILED 1MM AT 27 123-TSVB 27, 26,23 26 FAILED 1MM AT 27 12
• 3-TSVB 25,23,21 NONE NONE 183-TSVB 25,23,21 NONE NONE 18
• 3-ADVENT 26,23,22 NONE NONE 243-ADVENT 26,23,22 NONE NONE 24
• 3-TSVB 26,23,22 NONE NONE 123-TSVB 26,23,22 NONE NONE 12
• 3-TSVB 26,23,22 NONE NONE 183-TSVB 26,23,22 NONE NONE 18
• 2-TSVB 26,23 NONE 1MM AT 26 302-TSVB 26,23 NONE 1MM AT 26 30
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11. DiscussionDiscussion
• It is note worthy that a number of studies have had aIt is note worthy that a number of studies have had a
variety of patient criteria for measuring the performancevariety of patient criteria for measuring the performance
and out comes of procedures involving immediateand out comes of procedures involving immediate
loading of the anterior mandibleloading of the anterior mandible
• Such studies indicate that the bar’s ability both to reduceSuch studies indicate that the bar’s ability both to reduce
rotational movements and transfer vertical load to therotational movements and transfer vertical load to the
implants may have great deal to do with the successfulimplants may have great deal to do with the successful
osseointegration of immediately loaded implants inosseointegration of immediately loaded implants in
mandible.( implant dent 2006;15:24-34 )mandible.( implant dent 2006;15:24-34 )
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12. • An earlier study followed similar protocol , allowing aAn earlier study followed similar protocol , allowing a
number of implants to heal conventionally in case ofnumber of implants to heal conventionally in case of
failure of the immediately loaded implants.failure of the immediately loaded implants.
Considerations should include the possible choice ofConsiderations should include the possible choice of
implant systems designed for such an eventuality (J evidimplant systems designed for such an eventuality (J evid
based dent pract 2006;6;155-63)based dent pract 2006;6;155-63)
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13. conclusionconclusion
• Although this report covers a limited patientAlthough this report covers a limited patient
complement , it reflects success rates reported in thecomplement , it reflects success rates reported in the
literature for immediate and early loading of implantsliterature for immediate and early loading of implants
placed in the anterior mandible to support an overplaced in the anterior mandible to support an over
denture and also innovative use of impregum impressiondenture and also innovative use of impregum impression
materialsmaterials
• However immediate or delayed loading of implants in a 1However immediate or delayed loading of implants in a 1
stage protocol presents the clinician and patient witstage protocol presents the clinician and patient wit
numerous benefitsnumerous benefits
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14. • Thank you for your attentionThank you for your attention
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