Commentary

The success rate of dental implants in the aesthetic zone is of particular importance to both the general practitioner and the people we treat. Having the option to restore an implant immediately after placement rather than fabricating a transitional removable partial denture, or simply leaving the space edentulous, is of paramount importance to our patients, especially in the aesthetic zone.

In assessing the success rates of immediate, early and conventionally loaded dental implants, a recent study showed that the trends (there were no statistically significant differences) suggest that immediately loaded implants fail more frequently than those that are conventionally loaded, but less often than those loaded early. Therefore, if one wishes to load an implant early, it might be wise to load them immediately (within 1 week) rather than waiting for 1–2 months.1

This systematic review evaluated the outcomes of single tooth implants in the aesthetic zone where there were natural adjacent teeth. The investigators then compared immediate (within 48 h), early (>48 h but <3 months) and conventional (=3 months) loading treatment modalities. Although there are Cochrane reviews evaluating various aspects of dental implants, this systematic review may be considered of special significance because it evaluated those outcomes that are most important to our patients: longevity, aesthetics, and the subject's overall satisfaction with the end result of the treatment.

In terms of longevity, no statistically significant differences in implant survival were found in the clinical trials comparing immediate or early implant procedures with conventional ones. It has been shown that a high degree of implant stability (high value of insertion torque) is one of the prerequisites for a successful immediate/early loading procedure.2

In this systematic review, conclusions could not be drawn in terms of marginal bone changes when comparing the different treatment strategies, but it was shown that with respect to the peri-implant mucosa, the clinical crown height was acceptable in significantly more cases in the early placement groups than in the conventional groups. Although these clinical crown height results were based on only one study that was included in the review, one could reasonably assume that maintaining a clinical crown height that is closer to the “Golden Proportion” would lead to a more ideal aesthetic outcome and therefore higher patient satisfaction.

Even though reported satisfaction levels were high, only four of the studies in this systematic review evaluated this outcome. It is possible however, to suggest that implants placed with the immediate or early implant protocol might provide higher patient satisfaction and aesthetic outcomes than the conventional approach, possibly because of the preservation of the alveolar ridge.3

Although strong conclusions could not be drawn about which loading option is the overall treatment strategy of choice, and the fact that there needs to be more long-term research in respect to aesthetic outcomes and patient satisfaction, research tends to suggest that immediate placement and loading of dental implants could lead to a more satisfying experience for the patient, a better aesthetic outcome, and little added risk in terms of implant survival.

Practice points

  • It is possible to successfully load dental implants immediately or early after their placement in selected patients, but careful patient selection and treatment planning should precede this modality of treatment.

  • There is some indication that there is a correlation between aesthetic appearance before implant treatment and the final aesthetic result from both patients’ and the clinicians’ perspectives. There are doubts however, as to whether or not this is true for patient satisfaction. Patients who have a poor pre-operative condition might have a different attitude when comparing themselves against those that have a more ideal starting point.