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International Poster Journal of Dentistry and Oral Medicine



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Int Poster J Dent Oral Med 4 (2002), No. 3     15. Sep. 2002

Int Poster J Dent Oral Med 2002, Vol 4 No 3, Poster 130

Treatment of the Edentulous Mandible with Immediatly Loaded Implants

Language: English

Authors: Dr. Georg Bayer1, Dr. Dr. Paul Becker2, ZTM Kurt Beck2, PD Dr. Andrea Behneke3, Prof. Dr. Nikolaus Behneke3, Prof. Dr. Bernd d'Hoedt3, Dr. Günther Dhom4, Dr. Klaus Lotzkat5, Dr. Mathias Plöger6, Dr. Uli Koke7, Dr. Helmut Steveling7, Prof. Dr. Helmut Lindorf8, Dr. Ady Palti9, Dr. Peter Brabant10, DDS Stephen Wallace11
1Landsberg, Germany, 2Neunkirchen, Germany, 3Mainz, Germany, 4Ludwigshafen, Germany, 5Hannover, Germany, 6Detmold, Germany, 7Heidelberg, Germany, 8Nürnberg, Germany, 9Kraichtal, Germany, 10Waregem, Belgium, 11New York, USA,

April 15-17, 1999
8th International Congress on Reconstructive and Preprosthetic Surgery
San Diego, USA

Implant prosthetic planning for immediatly loaded implants

Fig. 1: Trapezoid position of four implants for immediate loading. Flap preparation for interforaminal placement of four implants.

Fig. 2: Most distal position for ideal anterior-posterior load distribution with nerve protection.

Fig. 3: FRIALOC® implants with diameter D 3.5 / D 4.0 and length L 10, L 13 and L 15.

Implant site preparation for D3.5 and D4.0 implants

Fig. 4: Pilot drill D 2.0
Initial preparation with pilot drill D2 of the IMZ®-TwinPlus or FRIALIT®-2 Implant System.

Drill D 3.0
Final preparation in bone density D II - D III with drill D 3.0 for D 3.5 mm implants.

Fig. 5: Drill D 3.3
Final preparation in average dense bone with drill D 3.3 for D 4.0 mm implants.
The same drill is used in dense bone for the enlargement of the receptor site for D 3.5 implants.

Drill D 3.6
In cortical bone D I an enlarge-ment with a drill D 3.6 guaran-tees an atraumatic placement of D 4.0 implants.

Fig. 6: Sequence of the drills according to the shape of the alveolar crest and bone quality.

Sterile packaging

Fig. 7: The implants are held by a silicone cap in the inner vial of the sterile packing.

Fig. 8: The placement instrument is attached directly to the sterile packaging.

Implant placement

Fig. 9: The placement of the implant is possible by handpiece or by ratchet. Irrigation with saline solution facilitates the implant placement especially in dense bone. Optimal primary stability is achieved with a torque of at least 45 Ncm.

Fig. 10: After final placement, the placement screws have to be removed.

Impression taking

Fig. 11: Placement of impression posts directly after implant placement.

Fig. 12: Repositioning of impression posts with implant analog.

Laboratory procedure

Fig. 13: Fixation of bar copings and bar with acrylic for soldering on master cast.

Fig. 14: Utilizing soldering analogs guarantees a passive fit of the final bar restoration. Polishing is the final step of the bar fabrication.

Final reconstruction

Fig. 15: Try-in of final bar restoration one day after surgery.

Fig. 16: Five months after prosthetic loading with overdenture.

Patient satisfaction level before and after treatment

  Are you satisfied with your denture in specific?
satisfied average unsatisfied very
Before implantation   5% 23% 14% 18% 41%
Recall 86% 14% 0% 0% 0%
  Satisfaction of the appearance of your denture?
  very good good average bad very bad
Before implantation   5% 50% 23% 9% 13%
Recall 64% 28% 8% 0% 0%
  How is the COMFORT of the denture?
Before implantation   0% 18% 9% 28% 45%
Recall 71% 29% 0% 0% 0%
  How well can you SPEAK with your denture?
Before implantation   18% 45% 23% 5% 9%
Recall 64% 36% 0% 0% 0%
  How well can you CHEW with your denture?
  very good good average bad very bad
Before implantation   0% 23% 9% 18% 50%
Recall 62% 38% 0% 0% 0%
  How often do you WEAR the denture?
  very often often average rare very rare
Before implantation   68% 9% 9% 0% 14%
Recall 93% 7% 0% 0% 0%
  Are you comfortable with your denture in social situations?
  YES NO  
Before implantation   67% 33%  
Recall 100% 0%  
  Would you have this treatment again?
Recall 100% 0%  
  Would you suggest this treatment to your friends?
Recall 100% 0%  
8th International Congress on Reconstructive and Preprosthetic Surgery, April 15-17, 1999, San Diego, USA



118 implants were placed in the edentulous mandible of 28 patients during the last 10 months. All patients were treated with a bar restoration or a cast superstructure immediately after surgery. One patient was not treated with a bar restoration immediately after implant placement because of inadequate primary implant stability. After three months of healing one implant showed no osseointegration. Primary stability was observed in all cases when the surgical protocol was adapted to the different bone qualities.
For an improved functional rehabilitation, six patients were restored with five implants supporting a screw-retained bridge with acrylic teeth. To adapt the prosthetic load, the patients were restored to first molar occlusion.
A well organized presurgical treatment sequence is necessary for implant placement and impressions in one session. The complex treatment within 24 hours requires careful guidance of the patient. The time effective treatment with less surgical and prosthetic complications is especially the elderly patient. Immediate loading of implants offers a new opportunity for the therapy of edentulous patients with implant supported superstructures in carefully selected indications with a strict protocol. 


  • Ledermann PD. Die neue Ledermannschraube. Die Quintessenz 5/1988;1-17
  • Tarnow DP, Emtiaz S, Classi A. Immediate loading of threated implants at stage 1 surgery in edentulous arches: Ten consecutive case reports with 1- to 5-year data. Int J Oral Maxillofac Implants 1997; 12:319-324
  • Chiapasco M, Gatti C, Rossi E, Haefliger W, Markwalder TH. Implant-retained mandibular overdentures with immediate loading. A retrospective multicenter study on 226 consecutive cases. Clin Oral Implants Res 1997; 8(1):48-57.


This poster was submitted by Dr. Jörg Neugebauer.

Correspondence address:
Dr. Jörg Neugebauer
Medical Center University to Cologne Clinic and Teaching Hospital for Dental Surgery and for Oral-,
Maxillo and Plastic Facial Surgery
Kerpener Strasse 32
D-50937 Köln