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To evaluate the outcome of two (fixed-on-2 = FO2) versus three (fixed-on-3 = FO3) implants placed flapless in fully edentulous jaws and immediately restored with metal-resin screw-retained crossarch prostheses.Forty edentulous or to be rendered edentulous patients (20 in the maxilla and 20 in the mandible) were randomised to the FO2 group (20 patients: 10 in the maxilla and 10 in the mandible) and to the FO3 group (20 patients: 10 in the maxilla and 10 in the mandible) according to a parallel group design. To be immediately loaded, implants had to be inserted with a minimum torque of 60 Ncm. Outcome measures were prosthesis and implant failures, complications and periimplant marginal bone level changes evaluated up to 1-year post-loading.Flaps were raised in four patients and two prostheses were loaded early at 8 weeks in the FO2 group. One year after loading no dropout or implant failure occurred, however one FO2 maxillary prosthesis had to be remade because of repeated screw-loosening (risk difference = 0.05; 95% CI: -0.05 to 0.15; Fisher's exact test P = 1.000). Three FO2 patients were affected by complications versus five FO3 patients (risk difference = -0.1; 95% CI: -0.35 to 0.15; Fisher's exact test; P = 0.695). There were no statistically significant differences for prosthetic failures and complications between groups. There were no statistically significant differences for marginal peri-implant bone levels between the two groups (estimate of the difference = 0.031 mm; 95% Cl: -0.22 to 0.28; P (ancova) = 0.803), with both groups losing marginal bone in a statistically significant way (0.27 mm for FO2 patients and 0.24 mm for FO3 patients).These preliminary results suggest that immediately loaded cross-arch prostheses can be supported by only two or three dental implants at least up to 1-year post-loading. Longer follow-ups are needed to properly evaluate both these therapeutic options.

To compare the outcome of cross-arch prostheses supported either by supershort (5 mm) or long (11.5 mm) implants, placed flapless and immediately restored with metal-resin screw-retained cross-arch prostheses.Thirty patients with edentulous (or to be rendered edentulous) mandibles and 30 with edentulous maxillas, who had sufficient bone to allow the placement of four and six implants respectively, which were at least 11.5 mm-long, were randomised according to a parallel group design into 2 equal groups, where they received either 5 mm or 11.5 mm-long implants at one centre. Implants with a diameter of 5 mm, were to be placed flapless with an insertion torque of at least 50 Ncm. Mandibles received four implants between the mental foramina. Implants were to be immediately loaded with metal-resin-definitive prostheses on the same day of implant placement. Patients were followed up to 1 year after loading and the outcome measures were: prosthesis and implant failures, complications, and peri-implant marginal bone level changes.No patients dropped-out. Two prostheses were remade, one on short maxillary implants and one on long mandibular implants. Two 5 mm maxillary implants which did not achieve 50 Ncm torque in soft bone of one patient, but were immediately loaded anyway, failed after 3 weeks compared to one mandibular 11.5 mm-long implant that failed after 60 days. Two complications occurred in each group. There were no statistically significant differences for prosthesis failures, implant failures and complications. Patients with mandibular short implants lost on average 0.08 mm of peri-implant bone at 1 year and patients with long mandibular implants lost 0.51 mm. Patients with short maxillary implants lost on average 0.15 mm of peri-implant bone at 1 year and patients with long maxillary implants lost 0.62 mm. Short implants showed less bone loss when compared to long implants and the differences up to 1 year were statistically significant both in maxillae (mean difference = 0.48 mm, 95% CI 0.22 to 0.73, P = 0.0011) and in mandibles (mean difference = 0.44 mm, 95% CI 0.21 to 0.66, P = 0.0009).Flapless-placed 5 mm-long implants achieved similar results as 11.5 mm-long implants when supporting immediately loaded cross-arch prostheses both in maxillae and mandibles up to 1 year after loading. These preliminary results must be confirmed by other trials, and 5- to 10-year post-loading data is necessary before making reliable recommendations.

To compare the outcome of immediately loaded single implants inserted with medium (from 25 to 35 Ncm) or high insertion torques (80 Ncm).Fifty patients received two single non-adjacent implants, each randomly inserted flapless with a torque between 25 to 35 Ncm or80 Ncm according to a split-mouth design. Non-occluding temporary crowns were immediately placed on provisional abutments and definitive crowns were delivered after 6 weeks. Patients were followed for 6 months after initial loading. Outcome measures were crown/implant failures, complications, peri-implant marginal bone level changes, postoperative pain and presence of peri-implant apical radiolucency.No drop-out occurred. Seven implants inserted with a torque between 25 to 35 Ncm failed versus none of the implants inserted with a torque35 Ncm. With the exception of crown/implant failures (exact McNemar significance P = 0.0156, difference in proportions: -0.12; 95% CI -0.21 to -0.02) there were no statistically significant differences between groups for the other outcome measures.It is preferable to insert single implants with a high insertion torque (80 Ncm), to minimise early implant failures, when loading them immediately.

To evaluate the clinical outcome of 2 implants placed flapless in fully edentulous mandibles and immediately restored with a metal-resin screw-retained cross-arch prosthesis 1 year after loading.Eighty consecutive patients were recruited. To be immediately loaded, implants had to be inserted with a minimum torque of 80 Ncm. Outcome measures, evaluated by two independent assessors, were prosthesis and implant failures, complications, marginal bone level changes, implant stability quotient (ISQ) values and patient satisfaction.Flaps were raised in 7 patients. Twelve implants in 7 patients did not reach the planned insertion torque. Four implants in 3 patients were immediately replaced by larger diameter implants and achieved the desired torque, whereas the remaining implants were immediately loaded anyway. Two implants failed early in 2 patients, but were successfully replaced and their prostheses remade. One month after loading, 72 (90%) patients declared to be completely satisfied with the therapy, 7 (9%) partially satisfied and 1 (1%) unsatisfied. One year after loading, all prostheses were in function, though one patient did not attend the 1-year control. Eight (10%) complications occurred, all successfully treated. After 1 year, the mean marginal bone loss was 0.3 mm and mean ISQ values decreased from 75.4 to 72.4.These short-term results at 1 year after loading suggest that immediately loaded mandibular cross-arch fixed prostheses can be supported by only 2 dental implants. Longer follow-ups (around 10 years) are needed to know the prognosis of this treatment modality.

To evaluate the efficacy of immediate loading versus early loading at 6 weeks of bar-retained mandibular overdentures supported by two implants placed with a flapless technique.Sixty patients were randomised: 30 to the immediately loaded group and 30 to the early loaded group. To be immediately loaded, implants had to be inserted with a minimum torque48 Ncm. Outcome measures were prosthesis and implant failures, biological and biomechanical complications, patient satisfaction, and Implant Stability Quotient (ISQ) assessed with a resonance frequency analysis instrument.Sixty implants were placed in each group. Flaps had to be raised in nine patients to check drill direction or to better visualise the area after multiple teeth extraction. Two implants in two patients did not reach the planned insertion torque and were immediately replaced by larger diameters ones. After 1 year no drop out occurred and two early loaded implants failed in two patients. There were no statistically significant differences between groups for prosthesis failures, implant losses, complications, and mean ISQ values; however, patients in the immediately loaded group were significantly more satisfied than those loaded early. When comparing mean ISQ values taken 6 weeks after placement with 1-year data within each group, values decreased significantly.Mandibular overdentures can be successfully loaded the same day of implant placement with a minimally invasive surgery, increasing patient satisfaction while decreasing treatment time and patient discomfort. No apparent advantages were seen when loading the overdentures at 6 weeks.

To evaluate the efficacy of 7-mm-long flapless placed single implants immediately or early loaded at 6 weeks.Thirty patients received two single Nanotite External Hex Biomet 3i implants that were then randomised for immediate or early loading. All implants had to be inserted with a minimum torque40Ncm. Provisional crowns were put in slight occlusal contact and replaced by definitive crowns 3 months after loading. Outcome measures were implant failures, biological and biomechanical complications, peri-implant marginal bone level changes and patient preference.Twenty-nine implants were immediately loaded and 31 early loaded. Thirteen flaps had to be elevated in 12 patients. Eleven implants in ten patients did not reach the planned insertion torque. Eight implants in seven patients were immediately replaced by implants with a larger diameter, two were loaded anyway, and one implant that was randomised to immediate loading was early loaded instead. Nine months after loading, no drop-out occurred. One implant failed in each group. There were no statistically significant differences between groups for implant losses, complications, mean marginal bone level changes, and patient preferences.Flapless placed 7-mm-long single implants can be successfully loaded the day of insertion. Longer follow-ups are needed to monitor the long-term prognosis of short implants.

To evaluate the efficacy of flapless placed implants immediately or early loaded at 2 months with full-arch prostheses.Thirty patients were randomised: 15 to the immediately loaded group and 15 to the early loaded group. All implants had to be inserted with a minimum torque48 Ncm. Outcome measures were prosthesis and implant failures, biological and biomechanical complications, peri-implant marginal bone level changes, patient satisfaction and implant stability quotient (ISQ) assessed with a resonance frequency analysis instrument.Ninety implants were placed in the immediately loaded and 87 in the early loaded group. Four localised flaps had to be elevated. Six implants in five patients did not reach the planned insertion torque. Four were immediately replaced by larger diameters ones, one was early loaded and another removed just after placement. After 1 year no drop-out occurred. One implant failed in the immediately loaded group versus three early loaded implants in two patients. There were no statistically significant differences between groups for implant losses, complications, and mean marginal bone level changes. There were borderline significant differences for mean ISQ values, and patients in the immediately loaded group were significantly more satisfied than those early loaded. When comparing mean ISQ values taken 2 months after placement with year 1 data within each group, values increased significantly.Maxillary cross-arch prostheses can be successfully loaded the same day of flapless implant placement, increasing patient satisfaction while decreasing treatment time and patient discomfort. No apparent advantages were seen when loading implants at 2 months.