FEATURE ARTICLE

The Evidence for Immediate Loading of Implants

David L. Cochran, DDS, PhD
From the Departments of Periodontics, The University of Texas Health Science Center
San Antonio, San Antonio, TX
INTRODUCTION
Many clinicians today recommend implant therapy for patients requiring tooth replacement. This therapy can provide
a highly successful restoration of both function and esthetics.
As such, more and more dentists are providing restorations
and patients are demanding these restorations. Along with
such an increase in procedures comes a desire to simplify the
experience in regard to many aspects including the time involved from starting the restoration to finishing the procedure. The shortest amount of time involved would be to
place the restoration on the implant immediately after the
surgical placement of the implant, a procedure called immediate restoration and/or loading. While immediate loading
has been discussed in the literature and papers report on this
technique, this procedure has not gained widespread acceptance. To understand the possibilities of immediate loading,
one must take a careful look at the implant procedure from a
historical perspective, from a biological perspective, and from
a prospective of the available literature on the topic. This is
the focus of this report.
One confounding area when discussing immediate loading
or any loading protocols is how various terms are defined.
Different investigators define certain terms different ways
and this can change the interpretation of the results of studies.
An example is how Bimmediate loading[ is defined or even the
term Bloaded.[ Some investigators suggest that placing an
implant into bone and submerging it below the soft tissues
results in loading of the implant. The rationale is that flexture
of the jawbone upon opening and closing and during chewing
exerts forces on the implant and thus Bloading[ the implant.
Others would suggest that an implant is loaded when it becomes visible in the oral cavity. This would occur when a nonsubmerged implant is used or when a submerged implants
closure screw becomes exposed through the soft tissue. The
rationale here is that tongue movements, cheek pressure, and
food could impact the top of the implant therefore placing a
Bload[ onto the implant. Other individuals would suggest that
the implant is not Bloaded[ until a temporary restoration or
implant component of some shape is placed onto the implant
Presented at the 2nd Evidence-Based Dentistry Conference
November 6, 2005
Chicago, Illinois
J Evid Base Dent Pract 2006;6:155<63
1532-3382/$35.00
2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.jebdp.2006.04.018

and is in the oral cavity but is not in occlusion with the opposing dentition. Again the rationale in these cases would be
tongue and cheek movements and food that would contact the
temporary restoration and the opposing dentition. Last, other
investigators and authors define Bloading[ as when the implant restoration is in direct contact with the opposing dentition. This is usually confirmed in centric occlusion with colored
occlusal marking paper or shim stock. This is a more objective
measure of loading and the term that will be used in this report
for the loading of an implant restoration.

HISTORICAL PERSPECTIVE
To understand the loading of implants, it is necessary to appreciate how loading protocols were established. Loading
protocols were arrived at originally by Branemark and associates1 while working out clinical protocols for placing implants. These investigators described 3 distinct phases of
development in the technique, which resulted in improved
success rates after each stage of trial and error. The initial stage
of development lasted from the mid 1960s until 1968. A development phase followed from 1968 until 1971 and then a
routine stage for the technique followed from 1971 until 1975.
During the early and development stages, one aspect that was
investigated was loading protocols. Various healing times were
evaluated and it was determined that shorter healing times resulted in failure of the implants. These findings suggested that
a healing time of 3 months was required in the mandible and
6 months of healing was required for the maxilla. These healing times were used by clinicians and in many studies and, as
such, 3 months in the mandible and 6 months in the maxilla
became recognized as conventional healing times.
The clinical experience that suggested a 3- and 6-month
healing time in the mandible and maxilla respectively did not
suggest a biological rationale for such a recommendation.
Szmukler-Moncler et al2 speculate on 4 possible biological
events that could account for the required healing times clinically established by Branemark et al.1 The first possibility
was that early loading would result in fibrous encapsulation
of the implant and no osseointegration. A second possibility
was that the overheated bone tissue, which undergoes necrosis from the osteotomy preparation, needs to be replaced and
during this time the tissue is not capable of supporting the
implant. A third possibility suggested was that the necrotic
bone created during osteotomy preparation is rapidly remodeled and turned over and that during the remodeling,
the strength of the bone to implant contact is compromised.
Last, it was speculated that the 3- to 6-month healing period

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was required in order to remodel bone adjacent to the boneimplant interface. This adjacent bone remodeling could compromise the ability to support the implant. Thus, several
scenarios were envisioned that could explain why an extended
healing period was required prior to loading of the implant.
The findings regarding healing times established by
Branemark et al1 were reinforced by work performed by
Roberts.3 These latter findings suggested that the same healing periods were required prior to loading the implant. Without such a healing time prior to loading, the bone to implant
interface was thought to be damaged by loading. Such reports
led to the establishment of the conventional healing periods.
These healing times were also reinforced by work during the
1970s in the orthopedic field.4<8 These studies all supported
the finding that micromotion resulted in fibrous tissue
encapsulation reinforcing the findings of Brannemark et al1
and Roberts.3 Thus, the predominance of research at that time
supported a relatively long undisturbed healing period.
As time passed, the observation was made that some implants could be loaded after shorter healing times and in
some cases, the implants could even be loaded immediately
after implant placement prior to any healing period. These
conflicting reports raised the question as to why, under some
conditions, implants become fibrous encapsulated while
under other conditions, the implants became osseointegrated.
Further investigation revealed that multiple factors played a
role in how micromotion influenced the healing process
around the implant. These factors were found to include the
magnitude of the load that was being applied to the implant
such that 50 to 150 microns of loading appeared to be tolerated (the implant became osseointegrated) under certain
conditions and higher loads could not be tolerated (the implants were encapsulated by fibrous tissues). The duration,
ie, the time and the frequency of the loading as well as the
direction of the loading, were found to be important factors.
Finally, the quality, quantity, and location of the surrounding bone also was found to influence the amount of micromotion that could be tolerated prior to changing the healing
outcome. As a consequence of this last factor, research on the
endosseous implant surface characteristics suggested that
relatively rough implant surfaces, particularly those without
porosity, were found to encourage more bone apposition to
the implant surface at earlier time periods. As such, research
on implant surface characteristics has significantly altered the
ability to load the dental implant.9
Another more recent observation is that under some conditions, investigators have reported that the success rates on
immediately loaded implants can be as high as success rates
on conventionally loaded implants.10 These findings reinforce a visionary statement made by Ledermann11 in 1979.
He suggested that the crucial factor for successful osseointegration was the stability of the implant during the healing
phase such that any motion at the bone-to-implant interface
was below a certain threshold. Other studies also suggest that
for osseointegration to occur, the mobility of the implant
must be maintained below a certain critical amount. Thus,
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the issue is not really the timing of the loading (immediate

loading or not) rather, it is the ability to minimize the motion
(less than 150 microns), during the healing process. If one
considers ways to clinically minimize motion during the healing process, several ways are possible and have been used
currently and in the past. These include (1) submerging the
implant into the bone tissue below the soft tissues; (2) placing
the implant into cortical bone coronally and apically, a process called bicortical stabilization; (3) rigid splinting of the
implants orally; (4) accelerating the rate of healing around the
implant; (5) providing cross-arch stabilization especially in
cortical bone; (6) keeping the implant restoration out of occlusion and/or opposing a denture rather than a tooth or
fixed partial denture; and (7) placing the implant with a large
amount of primary contact and/or including Bpress fitting[
the implant in the cortical bone created by flaring the top of
the implant. This last technique is performed by using drills
with slightly less diameters than the implant diameter or
preparing osteotomy sites smaller than recommended such as
not using the final bur in the preparation of the osteotomy
(Bunder drilling[) or using osteotomes to a diameter less than
the implant diameter. All of these clinical procedures can
minimize motion of the implant during the healing process
and have been used in clinical practice.
In retrospect, the evolution of implantology can be viewed
as falling into 3 phases or periods (Fig. 1). In the Development Period, relatively long healing times were recommended and primary stability (stability at the time of implant
placement) was considered to be very important. This period
occurred roughly in the 1960s and 1970s. A second phase
was an Exploration Period that followed in the 1980s and
1990s. During this period, many technological and procedural advances took place. These advances included changes
in implant surface characteristics, surgical procedural changes
such as Bunder drilling,[ and changes in the restorative procedures such as Bprogressive loading[ and tissue shaping
using the temporary restorations. Maybe most importantly,
however, was the realization that stability during the healing

Figure 1. Three periods of developments in implant dentistry and examples of concepts during the period.
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process was critical. In the final third phase, the Refinement

Period, shortened healing protocols have been investigated
and immediate loading protocols have been examined under
defined conditions. This Refinement Period has been occurring in the last 5 to 6 years since 2000. These evolutionary
periods have translated to patient care such that in the Development Period, techniques were developed to replace
teeth in edentulous patients. During the Exploratory Period,
these techniques were extended to provide tooth replacement
in partially edentulous patients, and in the Refinement Period
all these techniques are being optimized (Fig. 2).
Features of the evolutionary periods in implantology include the following. In the Development Period, the techniques were begun in edentulous patients, the techniques
were developed so that they became predictable, biocompatible materials were used, many implants were placed in each
patient, the implants had long undisturbed healing times of
3 to 9 months, implants were placed in high-quality (predominantly cortical dense) bone, cross-arch stabilization was
used, the opposing dentition was a denture, and, most significantly, there was minimal heating of the bone tissue during
implant surgery. The outcome of the Development Period
was help for the denture patient.
During the Exploration Period, the implant technique began to be applied to partially edentulous patients. The same
principles that had been learned in edentulous patients were
assumed to be valid for partially edentulous patients; however, various aspects of the techniques were examined for
their necessity since different clinical indications were being
used. Some questions that were raised and that have been
explored include the following: could the material the implants were made from change (eg, alloys of titanium rather
than pure titanium), could you oppose teeth or fixed partial
dentures rather than dentures with the implant restoration,
was cross-arch stabilization required, could the implants be
placed in lower quality bone, was bicortical stabilization necessary, could fewer implants be used including just a single
implant, did you need to cover (submerge) the implant under
the soft tissues in order to achieve osseointegration (although

Figure 2. Decades listed for the 3 development periods

also listing the predominant patients treated.
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Andre Schroeder had been using nonsubmerged implants

since the 1970s12 ), could you load the implant prior to the
3- to 9-month healing time, and could you place the implant
into extraction sites? The answers to these questions helped to
define the implant technique in partially edentulous patients
and thus benefited those patients missing 1 or more teeth.
By the time of the Refinement Period, dental implant placement became a routine successful tooth replacement therapy
for both edentulous and partially edentulous patients. Research during this time focused on optimizing surface characteristics of the implant including both morphology and
chemistry and exploring ways to further shorten the healing
times of the implant prior to restoration and loading, with the
ultimate goal of loading the implant immediately, meaning at
the time of implant placement. Also during the Refinement
Period, tissue-engineering techniques were introduced to enhance the rate of healing and the quantity and quality of bone
tissue around the implant (eg, the bone-to-implant contact).
The outcome of these improvements during the Refinement
Period led to the use of implant therapy to replace missing
teeth in more indications and thus more patients.

BIOLOGICAL CONSIDERATIONS
Loading protocols for endosseous dental implants can best
be interpreted on the biologic basis of how the tissues respond to implant placement. In fact, few appear to realize that
osseointegration occurs instantaneously on implant placement. Osseointegration was first defined as bone-to-implant
contact at the light microscopic level and then later defined as
a direct structural and functional connection between ordered living bone and the surface of a load-carrying implant.1 Cochran et al,13 in a study of the bone response to
implants with 2 different surface characteristics, stated that
when an implant is placed clinically into an osteotomy preparation, that the bone directly contacts the implant surface.
This results in immediate osseointegration of the implant as
defined by direct bone-to-implant contact if analyzed at the
light microscopic level. In fact, when an osteotomy site is
prepared, bone tissue is cut to a dimension of the implant
drill. This leaves edges of the bone surrounding the hole left
by the drill. More dense bone is found in the cortical areas
while less dense bone, in the form of interrupted trabeculae,
are found in areas of cancellous bone. When an implant is
then placed into the preparation, especially if the implant has
a slightly larger diameter than the implant drill, the implant is
Bpress-fit[ along the cut bone edges and the implant contacts
the bone, ie, is osseointegrated (bone-to-implant contact at the
light microscopic level). These areas of bone contact with the
implant surface are referred to as Bprimary bone contact.[13
Histologic analysis of such bone reveals intimate contact of
the bone with the implant surface (osseointegration) including lamellar plastic deformation, elongated Haversion systems, and micro-fractures in the bone (Fig. 3). Because bone
tissue is dynamic and remodels over time, these areas of bone
contact are remodeled and are replaced by new bone. This
Cochran

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new bone contact is termed Bsecondary bone formation.[

At the same time, new bone is also formed on the implant
surface (especially if the surface is osteoconductive) in areas
between the areas of primary bone contact. This new bone
is also termed Bsecondary bone formation.[ Thus, at early
time points there is a lot of primary bone contact along
the implant surface (dependent on the existing quantity
and quality of bone at the implant site) and very little secondary bone formation. At later time points, however, the
ratio reverses such that primary bone contact decreases and
secondary bone contact increases. This can be viewed diagrammatically as is shown in Fig. 4.
Histological analyses of large numbers of implants in patients is not possible, so clinical alternatives have been used
to determine if an implant is osseointegrated. One such sur-

Figure 3. Primary contact of implant with cortical bone.

Original magnification: X25. Compression of the cortical bone can be observed. Reprinted with permission
from Cochran DL, Schenk RK, Lussi A, Higginbottom
FL, Buser D. Bone response to unloaded and loaded titanium implants with a sandblasted and acid-etched surface: a histometric study in the canine mandible. J Biomed
Mater Res. 1998 Apr;40(1):1-11.13
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Figure 4. Schematic of bone contact against an implant

surface and what happens to the bone over time.

rogate for osseointegration is to determine if the implant is

stable in the jaw. Several methods are available to evaluate
stability and one more recent way is to use resonance frequency analyses. Barewal et al14 have followed the stability of
implants over early healing times with resonance frequency
measurements. Their findings indicated that implants placed
in areas of high bone quality are relatively stable over the
early healing periods. However, as the quality of bone decreases, the stability of the implant decreases over the first
3 to 4 weeks with the least stability found for those implants
in the lowest bone quality (Fig. 5). These findings suggest
that implants placed in high-quality bone are surrounded by
enough primary bone contact that stability of the implant
is maintained by the primary contact while the remodeling
and formation of new bone can occur to such a degree as to
further maintain the stability as measured by resonance frequency analyses (Fig. 6 and Fig. 7). However, when the implant is placed into a site with poor bone quality, very little
primary contact exists around the implant (Fig. 8 and Fig. 9).
As remodeling occurs, the implant becomes less stable because (1) the remodeling process in this case takes place in a
relatively high percentage of the bone surrounding the implant (little bone-to-implant contact initially because of poor
bone quality; therefore, as remodeling occurs, this represents
a large proportion of that small amount of bone), and (2)
there has not been sufficient time for new bone to form (secondary bone formation). Thus, stability of the implant as
measured by resonance frequency analyses reveals a significant decrease in stability between the time of primary
bone contact remodeling and the formation of new bone
or secondary bone contact. Therefore, the clinical stability
of implants in bone, as measured by resonance frequency
analyses, reflects the biological processes that are ongoing at
the bone-to-implant interface. These events further emphasize that Bosseointegration[ is not a static event but rather
represents a Bdynamic equilibrium[ at the site of boneto-implant contact. Thus, given this understanding, a new
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Figure 5. Stability of implants in different qualities of bone as detected by resonance frequency analyses over time. ISQ
is the implant stability quotient. Reprinted with permission from Barewal RM, Oates TW, Meredith N, Cochran DL.
Resonance frequency measurement of implant stability in vivo on implants with a sandblasted and acid-etched surface. Int
J Oral Maxillofac Implants. 2003 Sep-Oct; 18(5):641-51.14

definition of osseointegration could be Bstability of an

implant in bone that represents a dynamic equilibrium between existing native bone (primary bone contact) and remodeling and new bone formation (secondary bone contact),
and its maintenance, at the bone-implant interface[ (Fig. 10).

LITERATURE EXAMPLES
Understanding the biological consequences of implant integration allows an appreciation of what is possible in regard
to the loading of implants. These events are then reflected
by the literature on loading protocols. For instance, understanding that implants placed in excellent bone quality will
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be stable over the early healing periods and remain stable

(osseointegrated as defined above), suggests that multiple
implants placed in the anterior mandible and are rigidly fixed
orally can be successfully loaded. Thus, publications by
Babbush et al,15 Schnitman et al,16 Tarnow et al,17 and
Chiapasco et al18 are not surprising. Loading protocols in
other indications are certainly possible but the implant sites
must be carefully chosen as to reflect sites that can have high
bone quality, the implant restoration can be stabilized by
adjacent tooth structure etc, where implant stability can be
maintained in the transition from primary bone contact to
secondary bone contact. This is reflected in papers published
and in reviews of literature on this topic as noted below.
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Figure 6. The change in primary bone contact when an

implant placed in a site with a large proportion of dense
bone such as cortical bone.

Figure 8. The change in primary bone contact when an

implant is placed in a site with a large proportion of less
dense bone such as cancellous bone.

An example of a recent study evaluating implant loading

protocols examined various healing periods prior to loading
including no healing period, 10 days, 21 days, and 3 months
of loading.19 Teeth were extracted bilaterally in the canine
mandible and after 5 months, implants were placed at different time points such that each animal received 3 implants
at each of the 4 healing times. All gold, screw-retained crowns
were placed on all the implants the same day and radiographs taken at monthly intervals until the study animals
were killed at 3 months post-loading. Block sections were obtained from each implant site and histological analyses were
performed in addition to the monthly radiographic analyses
(Fig. 11 and Fig. 12). No implants were lost in spite of the
varying loading times and occlusal wear on the gold crowns.

The conclusions demonstrated that no significant differences

were found between the implants loaded after different healing times as evaluated clinically, radiographically, and histologically. Thus, both immediate and early loading of the
implants did not have adverse effects on the survival or success of the implants.
A meta-analysis was performed on more than 1000 implants in patients and compared loading times as evaluated
by implant survival.20 This article analyzed 13 prospective
clinical trials, 6 of which were randomized. Overall, no
significant differences were detected between loading protocols. Furthermore, although a higher actual number of failures occurred in the early loading protocols (2 to 6 weeks of
healing prior to loading) relative to the conventional loading

Figure 7. The stability of an implant placed in high quality bone is large (represented by a small gray area).

Figure 9. The lack of stability of an implant placed in

low quality bone (represented by large gray area).

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Figure 10. New definition of osseointegration reflecting

the dynamic biological processes that occur around an implant placed in bone.

protocol, there was no significant difference in the implant

failure rate between loading protocols. It should be noted
that conventional loading was defined as 3 to 6 months and
immediate loading from 1 to 2 days; however, early loading
included studies with a range of healing times (less than
14 days, within the first 35 days, and within the first 6
weeks). The authors noted a number of limitations of their
study including only 6 randomized studies out of a total
13 studies, only 1266 implants evaluated, all the trials being
underpowered, and the clinical heterogeneity of the studies.

An implant consensus conference was held in Gstaad,

Switzerland, in 2003 by the International Team for Oral
Implantology. One group at the consensus meeting evaluated immediate and early loading restoration and loading
protocols for dental implants.21 Three papers were submitted
that evaluated loading protocols in the literature related to
edentulous patients,22 partially edentulous patients,23 and
clinical techniques.24 After careful analyses and evaluation of
the literature reviews, an international group of 17 clinicians
made recommendations on loading protocols based on the
literature and the collective experience of the group. This
group determined that the volume of literature on loading
protocols was moderate and the evidence was limited at best
for the procedures considered. The predominant literature
was case reports. Loading was defined as contact with the
opposing dentition as opposed to restoration without contact.
Conventional healing was defined as 3 months postYimplant
placement until restoration, whereas immediate restoration
was defined as restoration within 48 hours of implant placement but not in occlusion with the opposing dentition. This
definition was based on the capacity to perform the restorative clinical procedures within a limited time frame from
surgery (such as the surgical placement occurring in one
office one day and the restorative procedures performed in

Figure 11. Histologic cross-sections of implants from a) Group A: 3 months, b) Group B: 21 days, c) Group C: 10 days,
d) Group D: 2 days after 3 months of loading. Reprinted with permission from Quinlan P, Nummikoski P, Schenk
R, Cagna D, Mellonig J, Higginbottom F, Lang K, Buser D, Cochran D. Immediate and early loading of SLA ITI
single-tooth implants: an in vivo study. Int J Oral Maxillofac Implants. 2005 May-June;20(3):360-70.19
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Figure 12. Tissue-to-implant contact between tissue

and primary and secondary bone, bone marrow, and connective tissue for Groups A (3 months), B (21 days), C
(10 days), and D (2 days). Bars indicate SE. Reprinted
with permission from Quinlan P, Nummikoski P, Schenk
R. Immediate and early loading of SLA ITI single-tooth
implants: an in vivo study. Int J Oral Maxillofac Implants. 2005 May-June;20(3):360-70.19

another office the next day). Early restoration was defined as

the placement of the restoration at least 48 hours subsequent
to implant placement but not later than 3 months. Immediate
loading was therefore defined as restoration within 48 hours
of implant placement and occlusal contact with the opposing
dentition. Early loading was therefore restoration at least
48 hours subsequent to implant placement but not later than
3 months and the restoration in contact with the opposing
dentition. The consensus group noted that the results of
the studies were obtained from conditions that were considered favorable in that the inclusion and exclusion criteria
used in many of the studies limited their evaluation to a selected population.
The consensus conference concluded that in the edentulous mandible, immediate loading (up to 48 hours) in patients
with both overdentures and fixed prostheses was well documented in the literature (Fig. 13). Early loading was separated into 2 periods based on studies in the literature. One
early loading period was between 48 hours and 6 weeks
and the second period from 6 weeks to 3 months. In the
edentulous mandible in the period of early loading from
48 hours to 6 weeks, the procedure for overdentures and
fixed prostheses was not well documented. In the period from
6 weeks to 3 months, no overdenture literature was available
but the literature on fixed prostheses was well documented.
In regard to the edentulous maxilla, no literature was available on overdentures that involved immediate or early loading (Fig. 14). In regard to fixed prosthesis in the edentulous
maxilla, literature was available on both immediate and early
loading; however, the group determined that this procedure
was not well documented in the literature. In regard to the
partially dentate maxilla and mandible, overdentures were not
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Figure 13. Loading documentation in the literature for

edentulous mandible. Reprinted with permission from
Cochran DL, Morton D, Weber HP. Consensus statements and recommended clinical procedures regarding
loading protocols for endosseous dental implants. Int J
Oral Maxillofac Implants. 2004;19 Suppl:109-13.21

applicable (Fig. 15). Fixed prostheses used in immediate restoration or loading indications in the partially dentate patient
were not well documented. In regard to early restoration or
loading in the partially dentate patient, the procedure was
well documented only after 6 to 8 weeks and then when an
implant was used with a roughened titanium surface.

CONCLUSION
A summary of loading protocols, based on historical development, biological considerations, and the literature indicate that shortened loading protocols are dependent on (1)
the quantity and quality of bone at the implant site and, as
a consequence, the amount of primary bone contact, and
(2) the rapidity of the bone formation and remodeling of the

Figure 14. Loading documentation in the literature for

edentulous maxilla. Reprinted with permission from
Cochran DL, Morton D, Weber HP. Consensus statements and recommended clinical procedures regarding
loading protocols for endosseous dental implants. Int J
Oral Maxillofac Implants. 2004;19 Suppl:109-13.21
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3.
4.
5.
6.
7.

8.
9.

Figure 15. Loading documentation in the literature for

partially dentate maxilla and mandible. Reprinted with
permission from Cochran DL, Morton D, Weber HP.
Consensus statements and recommended clinical procedures regarding loading protocols for endosseous dental
implants. Int J Oral Maxillofac Implants. 2004;19 Suppl:
109-13.21

10.

11.

12.

13.

bone surrounding the implant with resultant secondary bone

contact. These conditions result in 2 clinical scenarios for
supporting reduced healing times. If the implant site has high
quality and quantity of existing bone, immediate loading protocols are possible. If the implant site has low quality and
quantity of native bone and bone remodeling and bone
formation are required, immediate loading is more contraindicated and early loading protocols are possible. However,
many factors can be important such as the characteristics of
the implant surface, the location of high-quality bone in the
implant site, the ability to protect the implant restoration with
adjacent tooth structure, the use of proteins (growth factors
or stimulants) or materials and matrices used around the
implant, and so forth. These factors are related to either (1)
stimulating new bone-to-implant contact or (2) minimizing
micromotion of the implant. In all situations, it is important to remember that the goal is improved patient care.
Procedures that put the implant restoration at high risk in
the patient are unacceptable. Understanding the historical
development of implant healing times, the biological events
that result in osseointegration as defined above, and knowing
the literature on shortened healing times on implants, allows
the clinician to appreciate options for various loading protocols and to improve the patient care they deliver.

REFERENCES
1. Branemark PI, Hansson BO, Adell R, Breine U, Lindstrom J, Hallen O,
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2. Szmukler-Moncler S, Piattelli A, Favero GA, Dubruille JH. Considerations

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Roberts WE. Bone tissue interface. J Dent Educ 1988;52(12):804-9.
Schatzker J, Horne JG, Sumner-Smith G. The effect of movement on the
holding power of screws in bone. Clin Orthop 1975;111:257-62.
Cameron H, Macnab I, Pilliar R. Porous surfaced Vitallium staples. S
Afr J Surg 1972;10(2):63-70.
Cameron HU, Pilliar RM, MacNab I. The effect of movement on the
bonding of porous metal to bone. J Biomed Mater Res 1973;7(4):301-11.
Ducheyne P, De Meester P, Aernoudt E. Influence of a functional
dynamic loading on bone ingrowth into surface pores of orthopedic
implants. J Biomed Mater Res 1977;11(6):811-38.
Unthoff HK, Germain JP. The reversal of tissue differentiation around
screws. Clin Orthop 1975;123:248-52.
Cochran DL, Buser D, ten Bruggenkate CM, Weingart D, Taylor TD,
Bernard J-P, et al. The use of reduced healing times on ITI(R) implants
with a sandblasted and acid-etched (SLA) surface. Clin Oral Impl Res
2002;13(2):144-53.
Chiapasco M, Abati S, Romeo E, Vogel G. Implant-retained mandibular
overdentures with Branemark System MKII implants: a prospective
comparative study between delayed and immediate loading. Int J Oral
Maxillofac Implants 2001;16(4):537-46.
Ledermann P. [Complete denture support in edentulous problem mandibles with help from 4 titanium plasma-coated PDL screw implants].
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