Interventions for replacing missing teeth: different times for loading dental implants

  • Review
  • Intervention




To minimise the risk of implant failures after their placement, dental implants are kept load-free for 3 to 8 months to establish osseointegration (conventional loading). It would be beneficial if the healing period could be shortened without jeopardising implant success. Nowadays implants are loaded early and even immediately and it would be useful to know whether there is a difference in success rates between immediately and early loaded implants compared with conventionally loaded implants.


To evaluate the effects of (1) immediate (within 1 week), early (between 1 week and 2 months), and conventional (after 2 months) loading of osseointegrated implants; (2) immediate occlusal versus non-occlusal loading and early occlusal versus non-occlusal loading; (3) direct loading versus progressive loading immediately, early and conventionally.

Search methods

The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 8 June 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), MEDLINE via OVID (1946 to 8 June 2012) and EMBASE via OVID (1980 to 8 June 2012). Authors of identified trials were contacted to find unpublished randomised controlled trials (RCTs). There were no restrictions regarding language or date of publication.

Selection criteria

All RCTs of root-form osseointegrated dental implants, having a follow-up of 4 months to 1 year, comparing the same implant type immediately, early or conventionally loaded, occlusally or non-occlusally loaded, or progressively loaded or not. Outcome measures were: prosthesis and implant failures and radiographic marginal bone level changes.

Data collection and analysis

Data were independently extracted, in duplicate, by at least two review authors. Trial authors were contacted for missing information. Risk of bias was assessed for each trial by at least two review authors, and data were extracted independently, and in duplicate. Results were combined using fixed-effect models with mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). Summary of findings tables of the main findings were constructed.

Main results

Forty-five RCTs were identified and, from these, 26 trials including a total of 1217 participants and 2120 implants were included. Two trials were at low risk of bias, 12 were at high risk of bias and for the remaining 12 the risk of bias was unclear. In nine of the included studies there were no prosthetic failures within the first year, with no implant failures in seven studies and the mean rate of implant failure in all 26 trials was a low 2.5%. From 15 RCTs comparing immediate with conventional loading there was no evidence of a difference in either prosthesis failure (RR 1.90; 95% CI 0.67 to 5.34; 8 trials) or implant failure (RR 1.50; 95% CI 0.60 to 3.77; 10 trials) in the first year, but there is some evidence of a small reduction in bone loss favouring immediate loading (MD -0.10 mm; 95% CI -0.20 to -0.01; P = 0.03; 9 trials), with some heterogeneity (Tau² = 0.01; Chi² = 14.37, df = 8 (P = 0.07); I² = 44%). However, this very small difference may not be clinically important. From three RCTs which compared early loading with conventional loading, there is insufficient evidence to determine whether or not there is a clinically important difference in prosthesis failure, implant failure or bone loss. Six RCTs compared immediate and early loading and found insufficient evidence to determine whether or not there is a clinically important difference in prosthesis failure, implant failure or bone loss. From the two trials which compared occlusal loading with non-occlusal loading there is insufficient evidence to determine whether there is a clinically important difference in the outcomes of prosthesis failure, implant failure or bone loss. We did not identify any trials which evaluated progressive loading of implants.

Authors' conclusions

Overall there was no convincing evidence of a clinically important difference in prosthesis failure, implant failure, or bone loss associated with different loading times of implants. The quality of the evidence is assessed as very low due to high and unclear risk of bias of primary studies and there is some evidence of reporting bias so clinicians should treat these findings with caution. A high value of insertion torque (at least 35 Ncm) seems to be one of the prerequisites for a successful immediate/early loading procedure. More well-designed RCTs are needed and should be reported according to the CONSORT guidelines (, and registered with a trials registry.






(1)オッセオインテグレートインプラントの即時荷重(埋入後1週間以内)、早期荷重(埋入後1週間から2か月)、通常荷重(埋入後2か月) の比較、(2)即時咬合付与と非咬合荷重、早期咬合付与と非咬合荷重のそれぞれの比較、(3)直接荷重と暫増的荷重を、即時荷重、早期荷重、通常荷重のそれぞれを比較することを目的とする。


Cochrane Oral Health Group’s Trials Register(2012年6月8日まで)、Cochrane Central Register of Controlled Trials (CENTRAL、Cochrane Library 2012 Issue 4)、OVID経由でMEDLINE(1946年から2012年6月8日まで)、OVID経由でEMBASE(1980年から2012年6月8日まで)を検索した。特定された研究の著者には、未発表のランダム化比較試験(RCTs)を探すために連絡をとった。言語と発表年月日の制限は設けなかった。




データは、少なくとも2名のレビューアが別々に抽出した。不明な情報については、研究の著者に連絡をとった。Risk of biasは少なくとも2名のレビューアが評価し、データは2名のレビューアが独立してそれぞれ抽出した。結果は、連続値のアウトカムについては平均差(MD)として、二分値のアウトカムはリスク比(RR)として、95%信頼区間(C.I.)とともに、固定効果モデルによって結合を行った。おもな結果を示すSummary of findingsのテーブルを作成した。


45件のRCTが見つかり、そのうち1217名の被験者に対する2120本のインプラントを含む26件の研究が採用された。2件の研究はrisk of biasは低いと判定され、12件は高いリスク、残る12件のrisk of biasは不明と判断された。採用された研究のうち9件の研究では、最初の1年間では補綴物の失敗はみられず、7件の研究ではインプラントの失敗はみられず、26の研究全体の平均のインプラント失敗率は2.5%であった。即時荷重と通常荷重とを比較した15件のRCTでは、補綴物の失敗についても(RR 1.90;95% CI 0.67-5.34、8件の研究)インプラントの失敗についても(RR 1.50;95% CI 0.60-3.77、10件の研究)差を示すエビデンスはなかったが、即時荷重が骨吸収の抑制にやや有利であるとするエビデンス(MD -0.10mm;95% CI -0.20- -0.01;P=0.03;9件の研究)が、研究間の不均一性はあるものの(Tau²=0.01;Chi²=14.37,df=8(P=0.07);I²=44%)示されている。しかしながら、このわずかな差異は、臨床的には重要なものではないかもしれない。早期荷重と通常荷重とを比較した3件のRCTからは、補綴の失敗、インプラントの失敗、骨吸収に関わる臨床的に重要な差異があるのかどうかを決める十分なエビデンスは得られなかった。即時荷重と早期荷重を比較した6件のRCTにおいても、補綴の失敗、インプラントの失敗、骨吸収に関わる臨床的に重要な差異があるのかどうかを示すことはできなかった。咬合付与と非咬合付与とを比較した2件の研究においても、補綴の失敗、インプラントの失敗、骨吸収に関わる臨床的に重要な差異があるのかどうかを示すことはできなかった。インプラントへの暫増的荷重を評価する研究は見つからなかった。


全体的に見ると、インプラントへの荷重の時期に関しては、補綴の失敗、インプラントの失敗、骨吸収について臨床的に重要な差異があることを確信するエビデンスはなかった。もとになる研究の高い、あるいは不明なrisk of biasのために、エビデンスの質についてはとても低いと判定されており、また報告バイアスを示す根拠もあることから、臨床家は今回の結果については慎重に取り扱ってもらいたい。埋入時の高いトルク値(最低35N)は、即時あるいは早期荷重手技の成功のための必要条件のようである。さらによくデザインされたRCTが必要であり、その際にはCONSORTガイドライン(に沿って報告されるべきで、また研究登録がなされるべきである。


(翻訳 内藤 徹;JCOHR) CD003878.Pub5 2016.01.20登録 ご注意:この日本語訳は、臨床医、疫学研究者などによる翻訳のチェックを受けて公開していますが、訳語の間違いなどお気づきの点がございましたら、JCOHR事務局までご連絡ください。なお、2013年6月からコクラン・ライブラリーのNew review, Updated reviewとも日単位で更新されています。JCOHR事務局では最新版の日本語訳を掲載するよう努めておりますが、編集作業に伴うタイム・ラグが生じている場合もあります。ご利用に際しては、最新版(英語版)の内容をご確認ください。

Plain language summary

Interventions for replacing missing teeth: different times for loading dental implants

When people have dental implants in their jaws, they usually wait several months for the bone around the implants to heal before artificial teeth are attached to the implant. During this period they use removable dentures. This review looked at the effects of attaching artificial teeth either the same day that the implant was placed, or early (after only 6 weeks) compared to the usual delay of at least 3 months. Some studies also compared the artifical tooth being attached so that it did not touch the opposite tooth (non-occlusal loading). The search of studies was updated on 8th June 2012. The review found no evidence that attaching artificial teeth either immediately, after 6 weeks (early) or after at least 3 months (conventional) led to any important differences in the failure of the implant or the artifical tooth, or to the amount of bone which surrounded the implant (any bone loss would be an undesirable consequence). More research is needed in this area.

Laički sažetak

Intervencije za zamjenu zubi koji nedostaju: različito vrijeme stavljanja zubnih implantata

Kad osobe imaju zubne implanate u čeljusti, obično čekaju nekoliko mjeseci da kost oko implantata zacijeli prije nego se umjetni zubi pričvrste uz implantat. Tijekom tog razdoblja pacijenti nose mobilne proteze. Ovaj Cochrane sustavni pregled usporedio je učinak stavljanja umjetnih zubi isti dan kad su stavljeni implantati, ranog stavljanja (nakon samo 6 tjedana) i stavljanja umjetnih zubi nakon uobičajene odgode od najmanje 3 mjeseca. Neke studije su usporedile također način stavljanja umjetnih zubi na način da ne dodiruju suprotni zub (ne-okluzalno umetanje umjetnih zubi). Pretraživanje literature napravljeno je zaključno s datumom 8. lipnja 2012. Pronađeno je 26 studija s ukupno 1217 sudionika i 2120 implantata. Sustavni pregled nije našao dokaze da stavljanje umjetnih zubi odmah, ili nakon 6 tjedana (rano) ili nakon najmanje 3 mjeseca (standardni postupak) ima nekakve bitne razlike u uspjehu implantacije umjetnog zuba, ili količini kosti koja okružuje implantat (bilo kakav gubitak kosti bio bi nepoželjan). Potrebno je više istraživanja iz ovog područja.

Bilješke prijevoda

Cochrane Hrvatska
Prevela: Livia Puljak
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt:





(翻訳 内藤 徹;JCOHR) CD003878.Pub5 2016.01.20登録 ご注意:この日本語訳は、臨床医、疫学研究者などによる翻訳のチェックを受けて公開していますが、訳語の間違いなどお気づきの点がございましたら、JCOHR事務局までご連絡ください。なお、2013年6月からコクラン・ライブラリーのNew review, Updated reviewとも日単位で更新されています。JCOHR事務局では最新版の日本語訳を掲載するよう努めておりますが、編集作業に伴うタイム・ラグが生じている場合もあります。ご利用に際しては、最新版(英語版)の内容をご確認ください。

Ringkasan bahasa mudah

Intervensi untuk menggantikan kehilangan gigi: pelbagai jangkamasa untuk meletakkan implan pergigian

Setelah meletakkan implan pergigian di dalam rahang, pesakit perlu menunggu beberapa bulan untuk penyembuhan tulang di sekeliling implan sebelum gigi tiruan dilekatkan kepada implan. Dalam tempoh ini, mereka biasanya menggunakan dentur boleh tanggal.Ulasan ini melihat kepada kesan pemasangan gigi tiruan sama ada pada hari yang sama implan diletakkan, atau dipasang awal (selepas 6 minggu) berbanding penangguhan biasa iaitu sekurang-kurangnya 3 bulan. Beberapa kajian juga membandingkan gigi tiruan yang dipasangkan agar tidak bersentuhan dengan gigi yang bertentangan (tiada beban oklusal). Carian bagi kajian adalah terkini sehingga 8 Jun 2012.Ulasan ini tidak menjumpai bukti pemasangan gigi tiruan sama ada pada hari yang sama, selepas 6 minggu (awal) atau sekurang-kurangnya 3 bulan (konvensional) menghasilkan sebarang perbezaan utama dalam kegagalan implan atau gigi tiruan, atau juga amaun tulang yang mengelilingi implan (sebarang kehilangan tulang adalah akibat yang tidak diingini).Lebih banyak kajian diperlukan dalam hal ini.

Catatan terjemahan

Diterjemahkan oleh Noorliza Mastura Ismail (Kolej Perubatan Melaka-Manipa). Disunting oleh Norhayati Mohd Noor/Tuan Hairulnizam Tuan Kamauzaman (Universiti Sains Malaysia). Untuk pertanyaan tentang terjemahan ini, sila hubungi