Cochrane · intervention · CD003878

Interventions for replacing missing teeth: different times for loading dental implants

Esposito, M, Grusovin, MG, Maghaireh, H, et al. · Cochrane Database of Systematic Reviews · 2013 · Cochrane Library

Oral Health Implants and prosthodontics5 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

13

current version

GRADE rated

3

No studies

1

Included studies

26

as reported

No studies 1 · 7.7%Ungraded 9 · 69.2%Very low 3 · 23.1%Low 0 · 0%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Patients who are having osseointegrated root-form dental implants	Edentulous and partially edentulous jaws, adults only (n=1217 participants, 2120 implants in 26 trials)
Intervention	(1) Same implants loaded at different times (immediate/early/conventional); (2) same implants occlusally vs non-occlusally loaded during osseointegration; (3) same implants directly vs progressively loaded	Immediate loading; Early loading; Occlusal loading (26 trials; 2120 implants total)
Comparison	Conventional loading; Early loading; Immediate loading; Non-occlusal loading; Direct loading	Conventional loading; Early loading; Non-occlusal loading
Outcomes	Prosthesis failure if secondary to implant failure; Implant failures (implant mobility and removal of stable implants dictated by progressive marginal bone loss); Radiographic marginal bone level changes on intraoral radiographs taken with a parallel technique	Prosthesis failure (n=26 trials); Implant failure (n=26 trials); Marginal bone level changes (approx 14 trials)
Study designs	RCTs of parallel-group and split-mouth design of root-form osseointegrated dental implants with a follow-up of 4 months to 1 year after loading	RCTs, parallel-group and split-mouth design (26 trials)
Timing	Follow-up of 4 months to 1 year after loading	1 year (6-9 months data used for Oh 2006 and Cannizzaro 2008d; longer data used for some radiographs)

Search date: 2012-06. Databases: Cochrane Oral Health Group's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE

Questions and results

Current version only

Immediate loading vs Conventional loading

Population: Patients who are having osseointegrated root-form dental implants

CD003878.PUB5 (current) · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Implant failure 1 year same question in other reviews	RR 1.50 [0.60, 3.77]	10 studies	Ungraded
Prosthesis failure 1 year same question in other reviews	RR 1.90 [0.67, 5.34] 9 [-3, 43] more per 1000	8 studies · 381 participants	Very low Downgraded: risk of bias, publication bias
Marginal bone level changes 1 year same question in other reviews	MD -0.10 [-0.20, -0.01]	9 studies	Ungraded

Early loading vs Conventional loading

Population: Patients who are having osseointegrated root-form dental implants

CD003878.PUB5 (current) · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Implant failure 1 year same question in other reviews	RR 1.55 [0.46, 5.18]	2 studies	Ungraded
Marginal bone level changes 1 year same question in other reviews	MD -0.04 [-0.15, 0.07]	2 studies	Ungraded
Prosthesis failure 1 year same question in other reviews	RR 5.00 [0.63, 39.67] 40 [-4, 387] more per 1000	1 study · 48 participants	Very low Downgraded: risk of bias, publication bias

Immediate loading vs Early loading

Population: Patients who are having osseointegrated root-form dental implants

CD003878.PUB5 (current) · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Prosthesis failure 1 year same question in other reviews	RR 0.69 [0.25, 1.87] -15 [-37, 44] fewer per 1000	4 studies · 408 participants	Very low Downgraded: risk of bias, publication bias
Marginal bone level changes 1 year same question in other reviews	MD -0.06 [-0.16, 0.03]	3 studies	Ungraded
Implant failure 1 year same question in other reviews	RR 0.65 [0.26, 1.64]	5 studies	Ungraded

Occlusal loading vs Non-occlusal loading

Population: Patients who are having osseointegrated root-form dental implants

CD003878.PUB5 (current) · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Implant failure 1 year same question in other reviews	RR 1.00 [0.31, 3.22]	2 studies	Ungraded
Prosthesis failure 1 year same question in other reviews	RR 1.00 [0.31, 3.22]	2 studies	Ungraded
Marginal bone level changes 1 year same question in other reviews	MD 0.03 [-0.10, 0.15]	2 studies	Ungraded

Progressive loading vs Direct loading

Population: Patients who are having osseointegrated root-form dental implants

CD003878.PUB5 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR 1 year same question in other reviews	Progressive loading (direct vs progressive): no trial could be included; we did not identify any trials which evaluated progressive loading of implants.	0 studies	No studies

Immediate loading vs Conventional loading

Population: Patients who are having osseointegrated root-form dental implants

CD003878.PUB4 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Implant failure 1 year	RR 1.92 [0.70, 5.22]	8 studies	Ungraded
Marginal bone level changes 1 year	MD -0.10 [-0.24, 0.04]	6 studies	Ungraded
Prosthesis failure 1 year	RR 2.41 [0.76, 7.63] 14 [-2, 66] more per 1000	6 studies · 257 participants	Very low Downgraded: risk of bias, publication bias

Early loading vs Conventional loading

Population: Patients who are having osseointegrated root-form dental implants

CD003878.PUB4 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Marginal bone level changes 1 year	MD -0.04 [-0.15, 0.07]	2 studies	Ungraded
Implant failure 1 year	RR 1.15 [0.06, 22.33]	2 studies	Ungraded
Prosthesis failure 1 year	RR 5.00 [0.63, 39.67] 40 [-4, 387] more per 1000	1 study · 48 participants	Very low Downgraded: risk of bias, publication bias

Immediate loading vs Early loading

Population: Patients who are having osseointegrated root-form dental implants

CD003878.PUB4 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Implant failure 1 year	RR 0.65 [0.26, 1.63]	5 studies	Ungraded
Prosthesis failure 1 year	RR 0.68 [0.25, 1.86] -16 [-37, 43] fewer per 1000	4 studies · 408 participants	Low Downgraded: risk of bias, publication bias
Marginal bone level changes 1 year	MD -0.06 [-0.16, 0.03]	3 studies	Ungraded

Occlusal loading vs Non-occlusal loading

Population: Patients who are having osseointegrated root-form dental implants

CD003878.PUB4 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Implant failure 1 year	RR 0.67 [0.12, 3.64]	1 study	Ungraded
Prosthesis failure 1 year	RR 0.67 [0.12, 3.64]	1 study	Ungraded
Marginal bone level changes 1 year	MD 0.01 [-0.13, 0.14]	1 study	Ungraded

Immediate loading vs Conventional loading

Population: Patients who are having osseointegrated root-form dental implants

CD003878.PUB3 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Prosthesis failure 1 year	RR 1.98 [0.33, 11.70]	3 studies	Ungraded
Marginal bone level changes 1 year	MD -0.02 [-0.11, 0.07]	2 studies	Ungraded
Implant failure 1 year	RR 1.44 [0.38, 5.46]	6 studies	Ungraded

Early loading vs Conventional loading

Population: Patients who are having osseointegrated root-form dental implants

CD003878.PUB3 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Implant failure 1 year	RR 1.15 [0.06, 22.33]	2 studies	Ungraded
Marginal bone level changes 1 year	MD -0.04 [-0.15, 0.07]	2 studies	Ungraded
Prosthesis failure 1 year	RR 5.00 [0.63, 39.67]	1 study	Ungraded

Immediate loading vs Early loading

Population: Patients who are having osseointegrated root-form dental implants

CD003878.PUB3 · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Implant failure 1 year	RR 3.23 [0.14, 75.83]	1 study	Ungraded
Prosthesis failure 1 year	RR 3.23 [0.14, 75.83]	1 study	Ungraded

Immediate loading vs Conventional loading

Population: Patients who are having osseointegrated root-form oral implants

CD003878.PUB2 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Marginal bone level changes 1 year	Marginal bone not analysable for immediate vs conventional loading (peri-implant bone measured on panoramic radiographs and excluded).	0 studies	No studies
Implant failure 1 year	RR 0.63 [0.09, 4.67]	2 studies · 40 participants	Ungraded
Prosthesis failure 1 year	Meta-analysis could only be conducted for implant failure; no pooled estimate for prosthesis failure (totals not selected); no statistically significant difference (3 trials).	3 studies	Ungraded

Early loading vs Conventional loading

Population: Patients who are having osseointegrated root-form oral implants

CD003878.PUB2 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Marginal bone level changes 1 year	MD -0.04 [-0.15, 0.07]	2 studies · 72 participants	Ungraded
Prosthesis failure 1 year	No pooled estimate (totals not selected); no statistically significant difference (2 trials: Tawse-Smith 2002; Payne 2002).	2 studies	Ungraded
Implant failure 1 year	No pooled estimate (totals not selected); no statistically significant difference (2 trials).	2 studies	Ungraded

Immediate loading vs Conventional loading

Population: Patients who are having osseointegrated root-form oral implants

CD003878 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Implant failure 1 year	One trial (Chiapasco 2001): one implant failed in each group; no statistically significant difference for implant failure; totals not selected.	1 study · 20 participants	Ungraded
Marginal bone level changes 1 year	Marginal bone level changes not analysable for immediate vs conventional loading (0 studies; Chiapasco peri-implant bone measured on panoramic radiographs and excluded).	0 studies	No studies
Prosthesis failure 1 year	One trial (Chiapasco 2001): no statistically significant difference for prosthesis or implant failures after one year of function; totals not selected.	1 study · 20 participants	Ungraded

Early loading vs Conventional loading

Population: Patients who are having osseointegrated root-form oral implants

CD003878 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Implant failure 1 year	One trial (Tawse-Smith 2002): seven Steri-Oss implants failed in five early-loaded patients vs one conventionally loaded; no statistically significant difference; totals not selected.	1 study · 48 participants	Ungraded
Prosthesis failure 1 year	One trial (Tawse-Smith 2002): no statistically significant differences for prosthesis failures, implant failures and marginal bone loss after one year; totals not selected.	1 study · 48 participants	Ungraded
Marginal bone level changes 1 year	One trial (Tawse-Smith 2002): no statistically significant difference for marginal bone level changes; totals not selected.	1 study · 48 participants	Ungraded