IMMEDIATE VERSUS EARLY LOADING OF FLAPLESS PLACED DENTAL IMPLANTS: A SYSTEMATIC REVIEW

Statement of problem. The flapless implant technique is a predictable procedure with several advantages and a high overall implant survival rate. Immediate loading and early loading have been widely used in dental implant therapies and provide improved esthetics, with enhanced function and comfort. However, the scientific support for immediate or early loading approaches for flapless-placed dental implants is unclear. Purpose. The purpose of this systematic review was to assess the effectiveness and safety of the immediate versus early loading of dental implants with flapless placement. Material and methods. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CNKI database, VIP database, WANFANG Database, and World Health Organization International Clinical Trials Registry Platform Search Portal were searched (up to October 2012). The systematic review included clinical randomized controlled trials that compared immediate with early loading of flapless-placed dental implants to replace missing teeth in adult participants who were partially or completely edentulous. The selection of included studies, data extraction, and assessment of the quality of the studies and evidence were conducted independently by 2 reviewers. Results. Six articles that reported on 4 randomized controlled trials that involved 180 selected participants were included. The implant failure rate was from 0.0% to 3.3% in both immediate and early loading group's with flapless implantation. No statistically significant differences were found in implant failure rates, periimplant marginal bone-level changes, or complications between the 2 groups. More participants preferred immediate loading rather than waiting for nearly 2 months. Conclusions. Within the limitation of needing additional high-quality evidence, immediate and early loading of dental implants after flapless placement both demonstrated an acceptable short- to medium-term survival rate. Immediate loading seems more acceptable because of the time benefit.