Immediate, early and late loading of interforaminal implants by overdentures

Introduction: There are sometimes publications in the implantological literature about new records, in which time implants can be loaded. They are reporting about "one day" and "few hours". Sometimes there is no difference between prosthetical supply and functional loading. The definition of immediate loading is partially different. Objectives: Is it really possible to load immediately interforaminal implants under the conditions of the common dental practice? Which prosthetical concept permits this in the shortest time? Which components, methods and modifications are necessary? Material and methods: Four Ankylos® implants were inserted interforamial in the edentulous mandible. They were loaded under six different prosthetical conditions: A1 bar - immediate loading A2 bar - late loading B1 prefabricated conicle crowns (Syncone®) - immediate loading B2 prefabricated conicle crowns (Syncone®) - late loading C1 individual telescopic crowns - conventional (cast) technique C2 individual telescopic crowns - new methods (circonia, galvano) The components, the protocol and the characteristics were analyzed in consideration of the costs and the needed time until the completition. The impression and the loading were started immediately after the implant insertion. Late loadings were realized after a three-months healing periode and the exposure operation. Results: The definition of the functional loading of implants by hybride protheses is "Immediate" (within 24 hours), "Early" (within 3 days) and "Late" (within 6 weeks). The shortest possible time until the incorporation under realistic and reproductable conditions is: A1 Early loading in minimum 30 hours A2 Late loading with completition in about 2-3 weeks (german master lab) B1 Immediate loading in 24 hours B2 Late loading with completition in about 1-2 weeks (german master lab) C1 Late loading with completition in about 2-3 weeks (german master lab) C2 Late loading with completition in about 2-4 weeks (german master lab) Discussion: The meantime use of standard abutments and standard impression caps as a multi purpose deviceis necessary to simplify and increase the treatment and fabrication. The immediate loading with a definite hybride prosthesis is only possible under practice conditions by the using of the (conicle) crown system Syncone®. The cooperation with an import lab doesn't make sense because far distance causes longer distribution time. The shortening of the protocol by the modification of components and methods spares time and money. The intraoral connection of the impression caps by light curing acrylic resin allows the fabrication of a quick and precise "impression tray" for early loading by a bar: * fabrication of a partial cast to build the bar with quick-setting plaster * temporary bite registration with standard abutments as a support * resting of the definite bite registration device on standard abutments * fabrication of a device for the intraoral myofunctional bite registration on Syncone®-caps * Intraoral assembling and combinding of the secondary parts with the prosthesis by light- and self curing acrylic resin. Keywords: interforaminal implants, overdentures, time of loading, components, prosthetical concepts, protocol modification