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The protocols for implant loading have changed considerably over the years. Branemark's old way of delaying loading has become trendier at present. Today, we have immediate and early protocols being widely used. These latest methods try to shorten treatment time while ensuring that osseointegration remains stable. As the surface technology of implants has become advanced and as digital planning and biomechanical understanding have improved so much, the older concepts of safe functional loading can be redefined. There is still clinical uncertainty about the long-term predictability of early load initiation for implants of varying quality and design. This review critically reviews recent (2019–2025) evidence into the biologic and biomechanical principles, clinical and decision-making principles for immediate, early, progressive and delayed loading of implants. The goal is to create an effective, evidence-based framework that practitioners can use for loading selection according to patient-specific factors, bone density and primary stability. To achieve the aim, a structured narrative review was conducted, which involved the databases including PubMed, Scopus, ScienceDirect and Wiley Online Library. The literature was searched using Boolean search strings that combined appropriate MeSH terms pertaining to ‘dental implants’, ‘osseointegration’, ‘loading protocol’ and ‘primary stability’. Seventy-two studies (24 RCTs, 28 cohort studies and 20 systematic reviews/Meta-analysis) that met the inclusion criteria were qualitatively analyzed. When insertion torque was ≥ 35 N.cm, implant survival rates were between 95 and 100% in immediate and early loading protocols, comparable to that of delayed protocols. Similarly, for ISQ ≥ 70 and bone quality Type I–II. The difference in mean marginal bone loss between early and late loading was less than 0.2 mm at 12 months, which is clinically insignificant. Excess occlusal load, low bone density (type IV) and absence of prosthetic splinting were associated with failures. The implant bone interface in low-density bone improved as upgrades were made with progressive loaders. Implants in the lower jaw were more predictable than in the upper jaw. Immediate loading and early loading are both reliable if the biomechanical and biologic prerequisites are satisfied. This is a significant change from time-based loading to mechanically and biologically guided loading. Ways of working in the future will be AI-assisted torque analysis, digital bone-density mapping and biomimetic implant surfaces that enhance osseointegration under controlled functional load. Clinical Significance: Clinicians should determine the time of implant loading according to objective parameters rather than according to fixed timelines. Properly done immediate or early loading can shorten treatment time, improve patient satisfaction and provide long-term predictability comparable to those achieved with delayed approaches. Graphical Abstract

Implant dentistry constitutes a therapeutic modality in the prosthodontic treatment of partially and totally edentulous patients. This study reports a long-term evaluation of treatment by the early loading of acid-etched surface implants. Forty-eight partially and totally edentulous patients were treated with 169 TSA Defcon® acid-etched surface implants for prosthodontic rehabilitation. Implants were loaded after a healing free-loading period of 6–8 weeks in mandible and maxilla, respectively. Implant and prosthodontic clinical findings were followed during at least 17 years. Clinical results indicate a survival and success rate of implants of 92.9%, demonstrating that acid-etched surface achieves and maintains successful osseointegration. Five implants in three patients were lost during the healing period. Sixty-five prostheses were placed in 45 patients over the remaining 164 implants, 30 single crowns, 21 partially fixed bridges, 9 overdentures, and 5 full-arch fixed rehabilitations. A total of 12 implants were lost during the follow-up period. Mean marginal bone loss was 1.91 ± 1.24 mm, ranging from 1.1 to 3.6 mm. The most frequent complication was prosthetic technical complications (14.2%), followed by peri-implantitis (10.6%). The mean follow-up was of 214.4 months (208–228 months). Prosthodontic rehabilitation with an early-loading protocol over acid-etched surface implants is a successful implant treatment.

Background: Macro- and micro-geometry are among the factors influencing implant stability and potentially determining loading protocol. The purpose of this study was to test a protocol for early loading by controlling implant stability with the selection of fixtures with different thread depth according to the bone density of the implant site. Materials and Methods: Patients needing implant therapy for fixed prosthetic rehabilitation were treated by inserting fixtures with four different thread diameters, selected based on clinical assessment of bone quality at placement (D1, D2, D3, and D4, according to Misch classification). Final insertion torque (IT) and implant stability quotient (ISQ) were recorded at baseline and ISQ measurements repeated after one, two, three, and four weeks. At the three-week measurement (four weeks after implant replacement), implants with ISQ > 70 Ncm were functionally loaded with provisional restorations. Marginal bone level was radiographically measured 12 months after implant insertion. Results: Fourteen patients were treated with the insertion of forty implants: Among them, 39 implants showing ISQ > 70 after 3 weeks of healing were loaded with provisional restoration. Mean IT value was 82.3 ± 33.2 Ncm and varied between the four different types of bone (107.2 ± 35.6 Ncm, 74.7 ± 14.0 Ncm, 76.5 ± 31.1 Ncm, and 55.2 ± 22.6 Ncm in D1, D2, D3, and D4 bone, respectively). Results showed significant differences except between D2 and D3 bone types. Mean ISQ at baseline was 79.3 ± 4.3 and values in D1, D2, D3, and D4 bone were 81.9 ± 2.0, 81.1 ± 1.0, 78.3 ± 3.7, and 73.2 ± 4.9, respectively. Results showed significant differences except between D1 and D2 bone types. IT and ISQ showed a significant positive correlation when analyzing the entire sample (p = 0.0002) and D4 bone type (p = 0.0008). The correlation between IT and ISQ was not significant when considering D1, D2, and D3 types (p = 0.28; p = 0.31; p = 0.16, respectively). ISQ values showed a slight drop at three weeks for D1, D2, and D3 bone while remaining almost unchanged in D4 bone. At 12-month follow-up, all implants (39 early loading, 1 conventional loading) had satisfactory function, showing an average marginal bone loss of 0.12 ± 0.12 mm, when compared to baseline levels. Conclusion: Matching implant macro-geometry to bone density can lead to adequate implant stability both in hard and soft bone. High primary stability and limited implant stability loss during the first month of healing could allow the application of early loading protocols with predictable clinical outcomes.

(1) Introduction: The clinical success of dental implants depends on rapid osseointegration, which can be impaired by hydrocarbon contamination and biological aging of titanium surfaces. Chairside plasma surface treatment has emerged as a practical method to restore surface hydrophilicity and enhance early bone–implant integration. (2) Materials and Methods: This retrospective cohort study evaluated 73 plasma-treated implants placed in 47 patients from June 2023 to October 2024. Non-thermal atmospheric pressure plasma was applied immediately before placement using the ACTILINK™ Reborn system. Implant stability was assessed baseline, weekly for the first four weeks, and again at week 8 using resonance frequency analysis (ISQ). Subgroup analyses were conducted according to initial ISQ, jaw location, implant length/diameter, and final insertion torque. (3) Results: All implants healed uneventfully without a stability dip. Mean ISQ increased from 78.97 ± 5.52 at placement to 83.74 ± 4.36 at week 8 (p < 0.001). Implants with lower initial stability demonstrated the greatest relative gains, while those with very high initial stability showed minimal changes. Mandibular and shorter implants demonstrated higher stability gains compared to maxillary and longer fixtures. (4) Conclusions: Chairside plasma surface treatment was associated with progressive ISQ increases during the 8-week healing period. The greatest gains occurred in implants with lower initial stability, while very stable implants showed little change. Stability improvements were also greater in mandibular sites, shorter fixtures, and those with higher insertion torque. These findings are limited to short-term ISQ outcomes and require validation in prospective controlled trials with standardized protocols.

Background: Implant dentistry has evolved over time, resulting in better treatment outcomes for both patients and clinicians. The aim of this trial was to test whether the immediate loading of implants with a platform-switching design influences the marginal bone level, compared to four-week loading, after one year of follow-up. Moreover, a comparison of clinical data regarding implant survival, implant stability, and patient-reported outcome measures (PROMs) was conducted. Methods: Klockner® VEGA® implants with a ContacTi® surface were placed in partially edentulous patients in the posterior areas. Group A received an immediately loaded prosthesis (one week) and Group B received an early-loaded prosthesis (four weeks). All abutments were placed at the time of surgery. Radiographic and clinical data were recorded. Results: Twenty-one patients were treated (35 implants). No implants were lost during the study. The final marginal bone level did not show differences between groups. The bone loss at 12 months at the implant level was 0.00 mm for both groups (median). The final implant quotient stability (ISQ) values did not differ between groups (median 73 and 70.25), nor did the other clinical parameters or PROMs. Conclusions: The results suggest that neither of the loading protocols with the implants used influenced the marginal bone level—not the osseointegration rate, clinical conditions, or PROMs.

Purpose To evaluate early versus conventional loading in immediate implants for molars. This study aims to answer the following PICO (Patient, Intervention, Comparison, and Outcome) question: In patients over 18 years of age, does early loading of immediately placed implants in molar areas result in a similar implant survival rate and marginal bone loss as conventional loading? Methods Twenty-seven patients (15 women and 12 men) received a total of 30 implants immediately after molar extraction. The surgical treatment protocol entailed atraumatic tooth extraction without flap elevation. Non-invasive quantitative analyses were used to assess implant stability. After an uneventful healing period, the 30 implants were restored with screw-retained monolithic zirconia prosthesis, half of which after 6 weeks (G1) and the other half after 3 months (G2). Results Regarding the survival rate, the Kaplan–Meier and log-rank test showed that there was no statistically significant difference between both groups ( p  = 1). Implant stability quotient at the prosthetic phase of both groups (6 weeks in G1 and 3 months in G2) revealed no statistically significant difference (G1 RFA74.4 (SD 5.54) − DCA 79.07 (SD 5.75))/G2 RFA 73.67 (SD 5.7), − DCA78.93 (SD 4.48). Conclusions Early loading of immediately placed implants in molar sites is considered a predictable treatment modality provided that ideal implant position and adequate insertion torque are achieved.

The optimization of loading protocols following dental implant insertion requires setting up patient-specific protocols, customized according to the actual implant osseointegration, measured through quantitative, objective methods. Various devices for the assessment of implant stability as an indirect measure of implant osseointegration have been developed. They are analyzed here, introducing the respective physical models, outlining major advantages and critical aspects, and reporting their clinical performance. A careful discussion of underlying hypotheses is finally reported, as is a suggestion for further development of instrumentation and signal analysis.

The study evaluated the implant bone loss and stability of implant changes with diverse designs with early placement at eight weeks and eight months' time. The subjects for the current study had partial tooth loss in the posterior mandibular arch. A total of 30 samples were split into two groups of 15, one with a flared crest module and a buttress thread design, the other with a parallel crest module and a V-shaped thread design. Ostell assessed each subject's implant stability four times, at baseline, eight weeks, four months, and eight months. At intervals of eight weeks, four months, and eight months, intraoral periapical radiographs were examined using ImageJ software to measure crestal bone loss. When Group I and Group II's implant stability quotient (ISQ) values at baseline, eight weeks, four months, and eight months were compared; Group I's ISQ values at each of the four measured time periods were statistically significant. At eight weeks in Group I, the ISQ value was very considerable. At eight weeks, four months, and eight months, there was a statistically significant bone loss in Group II in comparison to Group I. At eight months, Group II's bone loss value was very considerable. In contrast to Group II implant designs, it was found that Group I implants demonstrated enhanced implant-less bone loss and stability.

Introduction: This study aimed to show the clinical outcomes of implants inserted by guided surgery supporting mandibular overdentures in edentulous patients. Patients and methods: Mandibular edentulous patients were diagnosed with an oral examination, cone-beam computerized tomography, and diagnostic casts for intermaxillary relations and treated with overdentures over two implants by guided surgery. After flapless surgery, implants were early loaded with an overdenture at 6 weeks. Results and discussion: Fourteen patients (nine females and five males) were treated with 28 implants. Four patients (28.6%) had a previous history of periodontitis. Five patients (35.7%) were smokers. Nine patients (64.3%) suffered from systemic diseases (i.e., diabetes, cardiovascular diseases). The clinical follow-up of the study was 44.7 ± 31.4 months. Clinical outcomes showed a global success of 100% of implants. Fourteen overdentures were placed in the patients over the implants. Mean marginal bone loss was 1.25 mm ± 0.95 mm. Four patients (28.6%) showed some kind of mechanical prosthodontic complications. Six implants (21.4%) were associated with peri-implantitis. Conclusions: This study indicates that treatment of mandibular edentulous patients with overdentures by guided surgery and early loading of implants placed appears to be a successful implant protocol.

Background Various surface treatment options have been adopted with the aim to improve osseointegration, reducing the overall treatment time. Implant stability of early loaded implants with different modified surfaces was compared in the present study. Methods Patients were selected from the Department of Oro-Maxillofacial Surgery and Stomatology at Semmelweis University. Patients randomly received SA (alumina sandblasted and acid-etched), NH (bioabsorbable apatite nanocoating) or SLA (large-grit sandblasted and acid-etched) surface implants. Outcome measures were: implant success, implant stability, and periodontal parameters. The implant stability was measured at the time of implant placement (primary stability) and six weeks after (prothesis delivery, secondary stability). Osstell and Periotest were applied to take all the measurements. The primary and secondary stability were compared in the three study groups Finally the periimplant probing depth appearing after three months of loading was checked on 6 points around to the implant-supported prostheses. Shapiro–Wilk and Mann–Whitney tests were used for the comparison between the study groups. Results A total of 75 implants with different length and diameter were inserted into various positions. One implant failed spontaneously at the fourth week after implant placement. The survival rate was 98,7%. Comparing the primary and secondary stability values, the data were significantly improved in every groups. The difference was the highest in the NH group, however, this difference was not significant compared to the two other groups. Good periodontal parameters were experienced in all the tested implants, independently by the groups. Conclusions With the limitation of the present study, all the implants showed improved stability six weeks after implant placement. A trend of higher result was found for the NH group. Further studies with longer follow-up are needed to confirm this preliminary results. Trial registration : Current Controlled Trials ISRCTN13181677; the date of registration: 04/03/2021. Retrospectively registered.