Immediate VS delayed implant loading: The current status of the literature

Purpose: Lately immediate loading of implants at the time of placement is becoming a viable treatment alternative, mainly in the aesthetic zone when replacing one or two teeth in the anterior maxilla. The main advantages are the reduction of patient discomfort, treatment duration and costs. In fact the patient could enter with an edentulismand leave the same day with an aesthetically acceptable implant-supported crown. The aim of this study is to compare the success rates and complications of immediately loaded implants with those of implants that were leaved to osseointegrate prior to loading. Materials and Methods: A systematic review of the literature was conducted through the MEDLINE (PubMed) database between 03/01/2007 and 03/01/2017 and completed by a hand search in ebsco database. Only the randomised controlled trials (RCT)were included. The following combination of MeSH terms was used: "Immediate Dental Implant Loading"[Majr] AND delayed implant loading AND complications. Two reviewers achieved screening and data abstraction. Results: The first search through PubMed provided 17 papers. Then, after selecting only the randomised controlled trials we obtained 7 papers, the hand search yielded 7 (RCT) out of which only 5 met the inclusion criteria after full text selection. Therefore we obtained 12 articles were found potentially right to be included (after full text selection). The most significant results were: It was suggested to under dimension the drilling to achieve a higher torque value leading to stability of the implant and thus to a better outcome for immediate loading. The occurrence of complications depended on bone quality, implant type, implant dimensions, site and timing of placement, and splinting. Most of the authors concluded no statistically significant differences between the immediate and the delayed procedure, and stated that both of them are viable options. Conclusion: Within the limitations of our review, it can be concluded that implants are, nowadays, able to obtain high torque values and acceptable success rates with excellent soft tissue healing when immediately loaded, as long as the patient selection is appropriate