What Is Conventional or Two Stage Dental Implant Loading?
According to numerous research studies conducted over the past decades, scientific evidence has emerged indicating that, after dental implantation in the jaw in preparation for a future prosthesis, titanium implants should ideally be left submerged to undergo a healing process. This period of healing allows the dental implant to properly integrate with the jawbone before the dental prosthesis is functionally loaded. This healing process is referred to as the phenomenon of 'osseointegration’ which should be completely achieved in a time between three to six months. The reason that is attributed to the long-term functional success of dental implants in individuals through this procedure of delayed or conventional loading of the dental prosthesis is so that all kinds of micro-movement on the implant can be avoided during the implicated time that is around three to six months on in which no other risk factors could be possible in interfering with the healing process, that is basically to achieve osseointegration (dental implant bone fusion into the jaw) successfully.
Further, the concept of conventional or delayed loading has the aim intended for dental operators to follow up on the dental implants in individuals during this osseointegration phase, to ensure the dental implant stability and fusion into the jaw are in check. This is to prevent the phenomenon of "fibro osseous integration" or preventing connective tissue formation in the bone-implant interface that would prevent proper fusion of the implant to the jaw bone- eventually resulting in impaired wound healing, connective tissue fusion of the implant and implant mobility, subsequent failure, etc. If fibro-osseous integration occurs, where connective tissue develops at the interface between the implant surface and the bone, it may compromise the dental implant. This is primarily because the connective tissue would be unable to withstand masticatory pressure, resulting in reduced resistance to masticatory forces and potential dental implant failure
What Is the Scope of Immediate Dental Implant Loading?
With the progressive development as well as the modern advent of several implant dentistry technologies and the widespread of implantation in dentistry over the years, a more recent research statistic has helped dental implant specialists or dental implantologists to focus on the mechanisms responsible for bone healing. Understanding these mechanisms has not only been easier for dental implant specialists around the globe with the advent of modern-day technology and 3D guided results, but it can also provide a better understanding of osseointegration, especially with the advent of 3D radiographic imaging techniques, surgical template guidance, virtual surgical planning 3D printing technologies and with even the new age developments of computer guided surgery in this field.
Hence the concept of immediate functional loading, where the prosthesis is loaded onto the dental implant without the usual phase or time lag required for osseointegration as in the conventional implant loading techniques that have been mentioned above.
Several dental researchers now suggest that it would be certainly possible to reduce the time between implantation and the placement of a dental prosthesis, because of technological advancements over the years in this field. Current research statistics show that patients in the immediate loading group report much higher satisfaction than the conventional loading group, with the end of a one-year observational period reports showing that there is no difference either in functional differences or in the postoperative pain or symptoms in patients of both the control groups (immediate versus conventional loading).
What Is the Research on Conventional Versus Immediate Loading of Dental Implants?
Over the past 20 years, some similar yet extensive research studies and trials have reported excellent results with "trans-mucosal implants" compared to the concept of submerged dental implants (that are preferred as two-stage dental implant procedures during conventional loading). According to these studies, it may not always be necessary to submerge the dental implants under the oral jaw mucosa during the healing period of three to six months. Rather a temporary prosthesis can be given so that the implant dentist can allow the patient to bite or chew foods even during the healing phase of osseointegration correctly.
The concept of immediate loading has also shown excellent research results because the primary outcomes of implant success were good and related to the long-term survival of the dental implant. A major research study showed that the implant survival rate was almost around 91.7 percent for immediately loaded implants after the two-year follow-up interval, with implant dentists regularly following up on the dental implant and the prosthetic rehabilitation, preventing any biologic or prosthetic complications in the follow-up phase. This highlights the importance of dental implantologists checking up on the implant's stability during the osseointegration or healing phase to promote the long-term survival rates of implants. 100 percent success rates have been as well reported in many edentulous patients over the last few years where transmucosal dental implants have been rehabilitated or treated with immediate full-arch implant prosthesis.
Coming to the convenience factor in dental implant patients, though most patients prefer that immediate loading rather than conventional loading be the ideal choice while undergoing dental implantation- this also depends on the decision taken by the dental implant specialists that is based on several general and aesthetic satisfaction factors and in consideration of the as postoperative outcomes, such as pain, edema (swelling) or the need for systemic medications required in some individuals. As every individual systemic and local dental health status tends to vary, it is upon the assessment and evaluation of these risk factors that the implantologist or the implant specialists would consider whether one needs to go for a conventional, delayed, or traditional loading method or the new age immediate loading method.
Conclusion:
Though dental implantologists would be able to make the right decision based on the medical and local dental status, current scientific evidence hence shows that both immediate and conventional loading protocols are equally effective in the long term or can be suited to prevent long-term dental implant failure, with regular dental follow ups post surgery being the key. According to the scientific research evidence pool, immediate loading is an advanced modality that can reduce treatment times, and promote early function and patient aesthetics, promoting desirable outcomes in dental patients.
