Loading Strategies

  • Mélanie Menassa
  • Thomas T. Nguyen


Implantology has offered an alternative to the conventional denture providing much more stability and retention. This alternative is referred to as an implant overdenture. According to The McGill Consensus Statement on Overdentures (Romanos, Advanced immediate loading, Quintessence Books, 2012, p. 179), the minimum standard of care for an edentulous mandible is a two-implant overdenture. Therefore, in the case of an edentulous mandible, conventional dentures should be considered an alternative treatment. In fact, there are several advantages of two-implant overdentures as they improve support, retention, and stability. Consequently, they improve the patients’ ability to chew food. Patients found implant overdentures more comfortable, and an ease of speech was noted in comparison with a conventional denture (Romanos, Advanced immediate loading, Quintessence Books, 2012, p. 179). Implant overdentures should also be considered for their benefits from a bone-conservation point of view. Implants stimulate the bone and help maintain its level (Davarpanah and Szmukler-Moncler, Manuel d’implantologie clinique: concepts, protocoles et innovations récentes, Paris, 2008).

The timing suggested for implant loading after placement of the implant, which also refers to the delivery of the prostheses, varies. Traditionally, there was a wait period of 3–6 months prior to implant loading in the mandible which is referred to as the conventional loading protocol, introduced initially by Brånemark (Javed and Romanos, J Dent 38:612–20, 2010). In order to reduce this wait period, other protocols have been introduced: immediate loading (under 1 week) and early loading (1 week to 2 months). Additionally, due to improved implant surfaces and techniques, conventional loading is now acceptable as of 2 months (Misch, Contemporary implant dentistry, Elsevier Health Sciences, 2007; Misch et al., J Oral Maxillofac Surg 57:700–6, 1999). There are numerous factors that come into play when determining the appropriate loading protocol.


  1. 1.
    Romanos GE. Advanced immediate loading. Hanover Park, IL: Quintessence Books; 2012. p. 179.Google Scholar
  2. 2.
    Davarpanah M, Szmukler-Moncler S. Manuel d’implantologie clinique: concepts, protocoles et innovations récentes. Paris: Wolters Kluwer France; 2008.Google Scholar
  3. 3.
    Javed F, Romanos GE. The role of primary stability for successful immediate loading of dental implants. A literature review. J Dent. 2010;38(8):612–20.PubMedCrossRefGoogle Scholar
  4. 4.
    Misch CE. Contemporary implant dentistry. Elsevier Health Sciences; 2007.Google Scholar
  5. 5.
    Misch CE, Qu Z, Bidez MW. Mechanical properties of trabecular bone in the human mandible: implications for dental implant treatment planning and surgical placement. J Oral Maxillofac Surg. 1999;57(6):700–6; discussion 706.PubMedCrossRefGoogle Scholar
  6. 6.
    Chatzigianni A, et al. Effect of mini-implant length and diameter on primary stability under loading with two force levels. Eur J Orthod. 2011;33(4):381–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Barikani H, et al. The effect of implant length and diameter on the primary stability in different bone types. J Dent (Tehran, Iran). 2013;10(5):449–55.Google Scholar
  8. 8.
    Davarpanah M, Szmukler-Moncler S, Molloy S. Théorie et pratique de la mise en charge immédiate. Paris: Quintessence International; 2007.Google Scholar
  9. 9.
    Lee SA, et al. Systematic review and meta-analysis of randomized controlled trials for the management of limited vertical height in the posterior region: short implants (5 to 8 mm) vs longer implants (>8 mm) in vertically augmented sites. Int J Oral Maxillofac Implants. 2014;29(5):1085–97.PubMedCrossRefGoogle Scholar
  10. 10.
    English C, et al. What are the clinical limitations of wide-diameter (4 mm or greater) root-form endosseous implants? Int J Oral Maxillofac Implants. 2000;15(2):293–6.PubMedGoogle Scholar
  11. 11.
    Renouard F, Nisand D. Impact of implant length and diameter on survival rates. Clin Oral Implants Res. 2006;17(Suppl 2):35–51.PubMedCrossRefGoogle Scholar
  12. 12.
    O’Sullivan D, et al. A comparison of two methods of enhancing implant primary stability. Clin Implant Dent Relat Res. 2004;6(1):48–57.PubMedCrossRefGoogle Scholar
  13. 13.
    O’Sullivan D, Sennerby L, Meredith N. Measurements comparing the initial stability of five designs of dental implants: a human cadaver study. Clin Implant Dent Relat Res. 2000;2(2):85–92.PubMedCrossRefGoogle Scholar
  14. 14.
    Sennerby L, Meredith N. Implant stability measurements using resonance frequency analysis: biological and biomechanical aspects and clinical implications. Periodontology 2000. 2008;47(1):51–66.PubMedCrossRefGoogle Scholar
  15. 15.
    Degidi M, Piattelli A. 7-year follow-up of 93 immediately loaded titanium dental implants. J Oral Implantol. 2005;31(1):25–31.PubMedCrossRefGoogle Scholar
  16. 16.
    Lorenzoni M, et al. Immediate loading of single-tooth implants in the anterior maxilla. Preliminary results after one year. Clin Oral Implants Res. 2003;14(2):180–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Barewal RM, Stanford C, Weesner TC. A randomized controlled clinical trial comparing the effects of three loading protocols on dental implant stability. Int J Oral Maxillofac Implants. 2012;27(4):945–56.PubMedGoogle Scholar
  18. 18.
    Friberg B, et al. On cutting torque measurements during implant placement: a 3-year clinical prospective study. Clin Implant Dent Relat Res. 1999;1(2):75–83.PubMedCrossRefGoogle Scholar
  19. 19.
    Johansson B, Back T, Hirsch JM. Cutting torque measurements in conjunction with implant placement in grafted and nongrafted maxillas as an objective evaluation of bone density: a possible method for identifying early implant failures? Clin Implant Dent Relat Res. 2004;6(1):9–15.PubMedCrossRefGoogle Scholar
  20. 20.
    Froum S. Dental implant complications: etiology, prevention, and treatment. Hoboken, NJ: Wiley; 2011.Google Scholar
  21. 21.
    Szmukler Moncler S, et al. Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature. J Biomed Mater Res. 1998;43(2):192–203.PubMedCrossRefGoogle Scholar
  22. 22.
    Davies JE. Understanding peri-implant endosseous healing. J Dent Educ. 2003;67(8):932–49.PubMedGoogle Scholar
  23. 23.
    Lang NP, et al. Early osseointegration to hydrophilic and hydrophobic implant surfaces in humans. Clin Oral Implants Res. 2011;22(4):349–56.PubMedCrossRefGoogle Scholar
  24. 24.
    Albrektsson T, et al. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1(1):11–25.PubMedGoogle Scholar
  25. 25.
    Smith DE, Zarb GA. Criteria for success of osseointegrated endosseous implants. J Prosthet Dent. 1989;62(5):567–72.PubMedCrossRefGoogle Scholar
  26. 26.
    Karthik K, et al. Evaluation of implant success: a review of past and present concepts. J Pharm Bioallied Sci. 2013;5(Suppl 1):S117–9.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Meredith N. Assessment of implant stability as a prognostic determinant. Int J Prosthodont. 1998;11(5):491–501.PubMedGoogle Scholar
  28. 28.
    Romanos GE, Nentwig GH. Immediate functional loading in the maxilla using implants with platform switching: five-year results. Int J Oral Maxillofac Implants. 2009;24(6):1106–12.PubMedGoogle Scholar
  29. 29.
    Romanos GE, Nentwig GH. Immediate versus delayed functional loading of implants in the posterior mandible: a 2-year prospective clinical study of 12 consecutive cases. Int J Periodontics Restorative Dent. 2006;26(5):459–69.PubMedGoogle Scholar
  30. 30.
    Henry PJ, Liddelow GJ. Immediate loading of dental implants. Aust Dent J. 2008;53(Suppl 1):S69–81.PubMedCrossRefGoogle Scholar
  31. 31.
    Aparicio C, Lang NP, Rangert B. Validity and clinical significance of biomechanical testing of implant/bone interface. Clin Oral Implants Res. 2006;17(Suppl 2):2–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Esposito M, et al. Interventions for replacing missing teeth: horizontal and vertical bone augmentation techniques for dental implant treatment. Cochrane Database Syst Rev. 2009;(4):Cd003607.Google Scholar
  33. 33.
    Adell R, et al. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg. 1981;10(6):387–416.PubMedCrossRefGoogle Scholar
  34. 34.
    Becker W, et al. One-step surgical placement of Branemark implants: a prospective multicenter clinical study. Int J Oral Maxillofac Implants. 1997;12(4):454–62.PubMedGoogle Scholar
  35. 35.
    Esposito M, et al. Interventions for replacing missing teeth: different times for loading dental implants. Cochrane Database Syst Rev. 2013;(3):CD003878.Google Scholar
  36. 36.
    Schimmel M, et al. Loading protocols for implant-supported overdentures in the edentulous jaw: a systematic review and meta-analysis. Int J Oral Maxillofac Implants. 2014;29(Suppl):271–86.PubMedCrossRefGoogle Scholar
  37. 37.
    Degidi M, Piattelli A. Immediate functional and non-functional loading of dental implants: a 2- to 60-month follow-up study of 646 titanium implants. J Periodontol. 2003;74(2):225–41.PubMedCrossRefGoogle Scholar
  38. 38.
    Awad MA, Feine JS. Measuring patient satisfaction with mandibular prostheses. Community Dent Oral Epidemiol. 1998;26(6):400–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Heydecke G, et al. Do mandibular implant overdentures and conventional complete dentures meet the expectations of edentulous patients? Quintessence Int. 2008;39(10):803–9.PubMedGoogle Scholar
  40. 40.
    Awad MA, et al. Determinants of patients’ treatment preferences in a clinical trial. Community Dent Oral Epidemiol. 2000;28(2):119–25.PubMedCrossRefGoogle Scholar
  41. 41.
    Buttel AE, et al. Immediate loading of two unsplinted mandibular implants in edentulous patients with an implant-retained overdenture: an observational study over two years. Schweiz Monatsschr Zahnmed. 2012;122(5):392–7.PubMedGoogle Scholar
  42. 42.
    Alfadda SA, Attard NJ, David LA. Five-year clinical results of immediately loaded dental implants using mandibular overdentures. Int J Prosthodont. 2009;22(4):368–73.PubMedGoogle Scholar
  43. 43.
    Liddelow G, Henry P. The immediately loaded single implant-retained mandibular overdenture: a 36-month prospective study. Int J Prosthodont. 2010;23(1):13–21.PubMedGoogle Scholar
  44. 44.
    Schnitman PA, et al. Ten-year results for Branemark implants immediately loaded with fixed prostheses at implant placement. Int J Oral Maxillofac Implants. 1997;12(4):495–503.PubMedGoogle Scholar
  45. 45.
    Menassa M, et al. Patients’ expectations, satisfaction, and quality of life with immediate loading protocol. Clin Oral Implants Res. 2016;27(1):83–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Liddelow GJ, Henry PJ. A prospective study of immediately loaded single implant-retained mandibular overdentures: preliminary one-year results. J Prosthet Dent. 2007;97(6 Suppl):S126–37.PubMedCrossRefGoogle Scholar
  47. 47.
    Emami E, et al. Does immediate loading affect clinical and patient-centered outcomes of mandibular 2-unsplinted-implant overdenture? A 2-year within-case analysis. J Dent. 2016;50:30–6.PubMedCrossRefGoogle Scholar
  48. 48.
    Avila G, et al. Immediate implant loading: current status from available literature. Implant Dent. 2007;16(3):235–45.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clin. dent. Hôpital JuifMontréalCanada
  2. 2.Department of Oral Health, Faculty of DentistryUniversity of MontrealMontrealCanada

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