Immediate Loading of Implant Overdentures Using Modified Loading Protocol Zeev Ormianer, DMD,* Arun K. Garg, DMD,† and Ady Palti, DMD‡ S uccessful osseointegration of dental implants has traditionally meant that clinicians allow for a stress-free healing period for implants. This 2-stage protocol initially calls for the submerging of several implants, which remain load-free for 3-6 months to ensure implant integration with the alveolar bone. However, the edentu- lous anterior mandible often lends it- self to immediate or delayed loading of implants in a 1-stage protocol, al- lowing the clinician and patient the benefits of a considerably shortened implant-to-restoration timeline. This process includes more patient comfort and less anxiety, as well as less ex- pense and more convenience for both the patient and clinician. 1-5 Although success rates are not as high for immediately loaded and early implants placed in a 2-stage protocol (and allowed to heal for several months before loading), conditions often war- rant the 1-stage surgical option, partic- ularly in the anterior mandible, even when systemic illness and smoking are not precluded from the patient crite- ria. 6,7 Of course, successful immediate loading or early loading procedures in the mandible require attention to a number of factors, including hard tis- sue (e.g., predictable osseointegration, bone loss) and soft tissue (e.g., esthet- ics, peri-implant health) concerns. 8 This report includes a limited patient complement but, nevertheless, con- firms the success rates reported in the literature for immediate and early loading of a limited number of im- plants placed in the anterior mandible to support an overdenture. It further suggests that the use of a common impression material to reduce the oc- clusal forces during the first several weeks of initial prosthetic use in- creases the likelihood for a successful outcome. MATERIALS AND METHODS A total of 10 patients, including 4 males and 6 females, with a mean age of 68 years (range 58-75), participated in the study. There were 6 patients who were completely edentulous. Four patients had teeth 6-11 in the maxilla, with removable partial den- tures. All patients were completely edentulous in the mandible, and all the implants were inserted in the mandible for immediate prosthetic restoration. Im- plants used in the study were Zimmer Dental, Tapered Screw-Vent 13  3.75 mm or Advent (Zimmer Dental, Carls- bad, CA) 13  4.7 mm. All patients in this study had ridges of adequate size and did not require membrane barriers or bone grafting to augment the alveolar bone. In addition to the prerequisite of ade- quate bone, patients could have no systemic illness that might cause delay in healing (e.g., diabetes). Further- more, the study required nonsmokers. Before surgery, final impressions of the arches were made, and working models were cast. The models were mounted in an articulator using face- bow and bite registration on occlusal rims for establishing the centric rela- tion. Tooth settings were made and confirmed by the patients. The settings were processed into the denture to re- line and retrofit onto the implants at surgery, and setting data were also du- plicated into a clear acrylic apparatus to be used as a surgical template to ensure that the implants were placed in an appropriate buccal-lingual position to allow for retrofitting of the denture onto the dental implants. The implants were placed according to the parame- ters established by the clear acrylic template. There were 3 implants placed in the anterior mandible, from mental foramen to mental foramen. Only 2 of the 3 implants were immediately loaded. The third was not activated so as to have it available in the event that 1 of the immediately loaded implants *Private practice, Ramat-Gan, Israel. †Professor of Surgery, Division of Oral/Maxillofacial Surgery, University of Miami School of Medicine, Miami, FL. ‡Clinical Professor, College Of Dentistry, New York University, New York, NY. ISSN 1056-6163/06/01501-035 Implant Dentistry Volume 15 • Number 1 Copyright © 2006 by Lippincott Williams & Wilkins DOI: 10.1097/01.id.0000202415.74206.79 To our knowledge, this study shows the first longitudinal results (range 12-30 months) of immediate loading of implant-support overden- ture with ball attachment connection placed in the anterior mandible. Im- mediately after surgery, the overden- ture was connected to the implants with 2-ball attachments. The housings were filled with Impregum TM (3M Espe AG; Seefeld, Germany) impres- sion material to provide retention as well as reduce forces in the initial phase of loading. Of the 28 im- plants placed, only 1 failed; the 1 failed implant for total implants placed represents a success rate of 96.4%. The minimal bone loss (1 mm) in 2 sites represents a success rate of 92.8%. (Implant Dent 2006; 15:35– 40) Key Words: immediate loading, oc- clusal forces, implant-supported over- dentures IMPLANT DENTISTRY /VOLUME 15, NUMBER 1 2006 35