Case Series Immediate Functional Loading of Dental Implants Supporting a Bar-Retained Maxillary Overdenture: Preliminary 12-Month Results Francesco Pieri,* Nicolo ` Nicoli Aldini, † Milena Fini, † Claudio Marchetti,* and Giuseppe Corinaldesi* Background: The present study evaluated the efficacy of a treatment consisting of placing and immediately loading implants with a bar-retained overdenture in edentulous maxillae. Methods: Twenty-two consecutive patients were treated with four or five implants rigidly connected with a bar, which were then loaded with a maxillary overdenture within 48 hours post-surgery. The pa- tients were followed clinically and radiographically for 1 year after loading. The implant outcome with regard to survival and success was analyzed. Visual analog scale questionnaires were used to record pa- tient function and satisfaction before and after im- plant treatment. Results: Of the 103 implants, three failed within 1 year. Two implants, although integrated, presented with marginal bone resorption (MBR) values higher than those proposed for successful implants. Cumula- tive survival and success rates of implants were 97.1% and 95.2%, respectively. The average MBR after 1 year was low (0.78 – 0.79 mm). The main prosthetic com- plication was the frequent need for complete relining of the prosthesis in the initial weeks after loading (27.2%). The questionnaire revealed a significant in- crease in all comfort, functional, and esthetic parame- ters (Friedman test; P <0.0001), except in the cleaning feasibility category; a significant decrease in satisfac- tion was observed in this category (Friedman test; P <0.05), indicating the difficulty patients had in maintaining a high level of oral hygiene. Conclusion: These preliminary results suggest that immediate loading of multiple implants supporting a bar-retained overdenture may represent a predict- able treatment option for the rehabilitation of the edentulous maxilla. J Periodontol 2009;80:1883- 1893. KEY WORDS Case series; dental implants; osseointegration; prosthodontics. I mplant-supported rehabilitation of totally edentu- lous patients has become a common and predict- able treatment modality in restorative dentistry. 1,2 Implant-supported overdentures represent the treat- ment of choice for patients who have lost all of their natural teeth but have problems retaining a complete denture, especially when opposed by natural denti- tion or a fixed or removable prosthesis supported by implants. 3-6 Usually when making implant-sup- ported overdentures in the maxilla, the matrices of the bar or the freestanding attachments are con- nected 3 to 8 months after implant placement, 7-9 when the process of osseointegration is considered clinically complete. During this critical healing phase, patients are asked not to wear any dentures for at least 2 weeks after the surgery, 10 and then a series of time-consuming appointments for soft relining are necessary to maintain denture stability without exposing the implants to uncontrolled pre- mature loading. 11 The immediate-loading technique has advantages of performing a single surgical procedure and of sat- isfying patient demand for a more rapid prosthetic treatment, especially in cases of edentulous arches in which longer waiting times may cause great dis- comfort due to a lack of denture stability and retention and decreased chewing ability. 12,13 Despite clinical studies 14,15 demonstrating that immediate loading of two to four implants splinted with a gold bar and re- taining a mandibular overdenture is a highly predict- able treatment procedure, limited and inconclusive data are available for the similar treatment of the edentulous maxilla. 16 In this pilot prospective study, we sought to deter- mine the predictability of performing maxillary over- denture treatment using a single-stage surgery and immediate prosthetic loading of multiple bar-con- nected dental implants. Follow-up data, including implant survival and success rates, after 1 year of occlusal loading are reported. * Oral and Maxillofacial Surgery Unit, Department of Dental Sciences, University of Bologna, Bologna, Italy. † Department of Experimental Surgery, Research Institute Codivilla-Putti, Rizzoli Orthopedic Institute, University of Bologna. doi: 10.1902/jop.2009.090227 J Periodontol • November 2009 1883