Implant Loading Protocols for the Partially Edentulous Esthetic Zone

Purpose: The scientific evidence related to different or novel implant loading (primary objective) and directly associated implant placement (secondary objective) protocols developed for the anterior maxillae of partially edentulous patients was reviewed. Materials and Methods: A comprehensive search of electronic databases and a hand search of six relevant journals was performed. The principal outcome variables were implant survival, implant success, and esthetic appearance. Concerning esthetic treatment outcomes, articles were specifically screened for the presence of objective evaluation parameters and patient satisfaction assessment. Results: The analysis of the literature on immediately restored or conventionally loaded implants in the esthetic zone revealed an initial survival rate of 97.3% after 1 year (10 prospective cohort studies and one case series). For periods of 1 to 5 years, the survival rate was 96.7%. These survival rates are consistent with previous reports on more traditional loading modalities. However, for immediately placed implants with immediate restoration and occlusal loading, the survival rate dropped by approximately 10% (four studies). Success criteria such as stable crestal bone levels, soft tissue recession, and probing depth could not be evaluated on the basis of the available literature. Conclusion: There is a paucity of prospective cohort studies addressing patient-centered outcomes. No parameters specific to immediate loading protocols were available for evaluation. In order to validate or reject such implant protocols for use in the esthetically sensitive anterior maxilla, long-term clinical trials should routinely include objective esthetic criteria that comprehensively embrace the pertinent elements of "pink and white esthetics" in the form of readily used indices. Keywords: anterior mandible, anterior maxilla, dental implants, esthetics, fixed dental prostheses, loading protocol, partial edentulism, single crown, systematic review