Two adjacent implant-supported restorations in the aesthetic region: A 10-year prospective case series.

INTRODUCTION: The treatment outcome of two adjacent implant-supported restorations in the maxillary aesthetic region was assessed regarding peri-implant soft and hard tissues, and satisfaction during a 10-year follow-up period. METHODS: Twenty patients missing two adjacent teeth in the maxillary aesthetic region and treated with two implant-supported restorations were followed prospectively. The patients' clinical and radiographic parameters, as well as their satisfaction, were scored for a 10-year follow-up period. RESULTS: Seventeen patients' data were available for the 10-year follow-up. The survival rate of the implants and restorations was 100%. The 10-year mean peri-implant bone change at the side facing the adjacent tooth was +0.11 ± 0.57 mm and at the side facing the adjacent implant was -0.08 ± 0.50 mm. The peri-implant soft tissues were healthy and the patients' satisfaction was high, but the papilla-index showed compromised inter-implant papillae and low Pink Esthetic Scores. These figures were of the same magnitude at all time points. CONCLUSION: While it is difficult to obtain sufficient inter-implant papillae and satisfactory Pink Esthetic Scores, the initial treatment results remained stable and the patients were satisfied with the final result throughout the 10-year follow-up period.

Dental implant treatment for two adjacent missing teeth in the esthetic region: A systematic review and 10-year results of a prospective comparative pilot study.

OBJECTIVES: The aim of the systematic review was to compare studies on implant-supported two-unit cantilever crowns with two adjacent implant-supported crowns in the anterior region. The second aim was to assess in a 10-year prospective comparative pilot study, hard and soft peri-implant tissue changes in patients with a missing central and adjacent lateral upper incisor, treated with either an implant-supported two-unit cantilever crown or two single implant-supported crowns. MATERIALS AND METHODS: Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched (last search March 1, 2023). Inclusion criteria were studies reporting outcomes of two missing adjacent teeth in the esthetic region and treated with a single implant-supported two-unit cantilever fixed dental prosthesis, or with two solitary implant-supported crowns. Outcome measures assessed included implant survival (primary), changes in marginal bone and gingiva level, restoration survival, subjective and objective esthetic scores, papilla volume, mid-facial marginal mucosa level, probing depth, bleeding on probing, and biological and technical complications with ≥1-year follow-up. In addition, in a 10-year pilot study, the same outcome measures were assessed of five patients with a single implant-supported two-unit cantilever crown and compared with five patients with two adjacent single implant-supported crowns in the esthetic zone. RESULTS: Nine articles with 11 study groups were found eligible for data extraction. Meta-analyses of implant survival rates were 96.9% (mean follow-up 3.4 ± 1.4 years) for the implant-cantilever treatment and 97.6% (mean follow-up 3.0 ± 1.8 years) for the adjacent implants treatment (p = .79). In the 10-year comparative pilot study, no clinically relevant changes in hard and soft peri-implant tissue levels occurred in both groups. Patient satisfaction was also high in both groups. CONCLUSION: Single implant-supported two-unit crowns can be a viable alternative to the placement of two adjacent single implant crowns in the esthetic zone.

Single implants in the aesthetic region preceded by local ridge augmentation; a 10-year randomized controlled trial.

OBJECTIVES: The aim of this randomized controlled trial was to assess the 10-year effects of three different augmentation techniques (augmentation with chin bone, augmentation with chin bone plus a membrane and augmentation with a bone substitute plus a membrane) for implant-supported restorations in the maxillary aesthetic region regarding clinical and radiographic parameters, and patient-centred outcomes. MATERIALS AND METHODS: Ninety-three patients requesting single tooth replacement and presenting with a horizontal bone deficiency were included. After augmentation, 93 implants were placed. Clinical variables, standardized radiographs and photographs and patient questionnaires were analysed to assess the impact of the various augmentation techniques 1 month (T1 ), 12 months (T12 ) and 120 months (T120 ) after final crown placement. RESULTS: 10-years implant survival was 95.7% and did not differ between the groups neither were significant differences observed in the other treatment outcomes assessed. Peri-implant bone loss was low, viz. 0.48 ± 1.19 mm (mesial) and 0.30 ± 1.24 mm (distal) at T120 . Loss of midbuccal marginal gingival level at T120 was 0.32 ± 0.83 mm. Mean overall satisfaction at T120 was 8.6 with 98.6% of the patients satisfied. CONCLUSIONS: Clinical, radiographic, aesthetic and patient centred outcomes were very favourable after 10 years and did not differ between the groups with different bone augmentation techniques.

Immediate Loading of Anterior Single-Tooth Implants Placed in Healed Sites: Five-Year Results of a Randomized Clinical Trial.

PURPOSE: The aim of this study was to compare the 5-year outcome of immediate loading with that of conventional loading for anterior single-tooth implants placed in healed sites. It was hypothesized that immediate loading is not inferior to conventional loading. MATERIALS AND METHODS: A total of 62 patients with a missing maxillary anterior tooth were included. At random, patients were treated with an implant that was restored either with a nonoccluding temporary crown within 24 hours after implant placement (immediate group) or according to a two-stage procedure after 3 months (conventional group). All implants were placed in healed sites. Follow-up visits were performed after definitive crown delivery and 1 and 5 years thereafter. Outcome measures were radiographic marginal bone level changes, implant survival, complications, soft tissue aspects (probing depth, plaque, bleeding, soft tissue level changes), esthetic outcome, and patient satisfaction. RESULTS: Three patients in each study group were lost to follow-up. No significant differences were found in terms of marginal bone loss (1.16 ± 0.93 mm in the immediate group and 1.20 ± 1.10 mm in the conventional group), survival (one implant lost in the immediate group), complications, soft tissue aspects, esthetic outcome, and patient satisfaction. CONCLUSION: For anterior single-tooth implants placed in healed sites, the outcome of immediate loading is not inferior to conventional loading.

Treatment Outcome of Two Adjacent Implant-Supported Restorations with Different Implant Platform Designs in the Esthetic Region: A Five-Year Randomized Clinical Trial.

PURPOSE: The aim of this study was to evaluate the peri-implant soft and hard tissues and satisfaction in patients with two adjacent implant-supported restorations in the esthetic region, treated with two adjacent implants with a scalloped or flat platform. MATERIALS AND METHODS: The randomized clinical trial consisted of 40 patients allocated to either a scalloped implant group consisting of 20 patients or a flat implant group of 20 patients. Clinical and radiographic examinations were performed during a 5-year followup period, and patient satisfaction during the same period was assessed. RESULTS: The scalloped implant group showed significantly more marginal bone loss (scalloped: 3.2 ± 1.1 mm; flat: 1.5 ± 0.8 mm) and significantly greater bone loss at the interimplant bone crest (scalloped: 2.4 ± 1.0 mm; flat: 1.3 ± 1.0 mm). Furthermore, peri-implant soft tissues showed significantly more bleeding when provided with scalloped implants than with flat implants. Papilla index scores were low in both groups. Patient satisfaction was high in both groups. CONCLUSION: More bone loss and compromised interimplant papilla regeneration were noted around scalloped implants in the first year, and stable results were observed in the subsequent 4 years with both systems. Scalloped implants seem to offer no benefit when compared to conventional flat implants in the esthetic region.

The extremely resorbed mandible, 10-year results of a randomized controlled trial on 3 treatment strategies.

OBJECTIVES: To prospectively compare the clinical and radiographic results of three modes of implant treatment for implant-retained mandibular overdentures in patients with extremely resorbed mandibles. The three treatment strategies used were (1) a transmandibular implant, (2) augmentation of the mandible with an autologous bone graft followed by placement of four endosseous implants, and (3) placement of four short endosseous implants. MATERIALS AND METHODS: Sixty edentulous patients met the inclusion criteria and were assigned according to a balanced allocation method to 1 of the 3 treatment strategies. Implant survival, surgical retreatment rates, and peri-implant bone loss were assessed according to a standardized protocol during a 10-year evaluation period. RESULTS: During the evaluation period, significantly more implants were lost in the transmandibular implant (cumulative 10-year implant survival rate, 76.3%) and the augmentation groups (88%) compared to the group provided with short endosseous implants (98.8%). The 10-year retreatment rate was significantly more favorable in the endosseous implants only (0%) and augmentation groups (5%) compared to the transmandibular group (30%). In all three groups, there was minor peri-implant bone loss. DISCUSSION: Although implant loss is a frequently used outcome measure for success, the necessity of surgical retreatment seems to be of more relevance for both the patient and the clinician. CONCLUSION: Considering the favorable clinical and radiographic parameters and the fact that patients can be treated in outdoor clinic setting, the use of short endosseous implants in combination with an overdenture is the first choice of treatment in patients with extremely resorbed mandibles.

Single-tooth implants with different neck designs: a randomized clinical trial evaluating the aesthetic outcome.

AIM: To evaluate the aesthetic outcome of single-tooth implants in the aesthetic zone with different neck designs from a professional's and patient's perception. MATERIALS AND METHODS: Ninety-three patients with a missing anterior tooth in the maxilla were randomly assigned to be treated with an implant with a smooth neck, a rough neck with grooves or a scalloped rough neck with grooves. Implants were installed in healed sites. One year after definitive crown placement (18 months post-implant placement), photographs were taken and the aesthetic outcome was assessed according to two objective aesthetic indexes: pink esthetic score/white esthetic score (PES/WES) and implant crown aesthetic index (ICAI). A questionnaire was used to assess the aesthetic outcome and general satisfaction from a patient's perception. standardized radiographs were taken to measure marginal bone level changes. RESULTS: One implant was lost. Although there was a significant difference in marginal bone loss between the different implant neck designs (smooth neck 1.19±0.82mm, rough neck 0.90±0.57mm, scalloped neck 2.01±0.77mm), there were no differences in aesthetic outcome. According to the professional's assessments using PES/WES and ICAI, 79.3% and 62% of the cases showed acceptable crown aesthetics, and 59.8% and 56.5% of the cases showed acceptable mucosa aesthetics. Overall, patients were satisfied about the aesthetics of the mucosa (81.5%) and crown (93.3%), and general patient satisfaction was high (9.0±1.0 out of a maximum of 10). According to the professional's assessment, a pre-implant augmentation procedure was associated with less favorable aesthetics of the mucosa. CONCLUSION: This study shows that the aesthetics of single-tooth implants in the maxillary aesthetic zone appears to be independent of the implant neck designs applied but dependent on the need for pre-implant surgery.

Oral rehabilitation with implant-based prostheses of two adult patients treated for childhood rhabdomyosarcoma.

BACKGROUND: Rhabdomyosarcoma is the most common malignant tumor in the nasal and paranasal sinus area at childhood. Multimodal treatment for this disorder has severe side effects due to normal tissue damage. As a result of this treatment, facial growth retardation and oral abnormalities such as malformation of teeth and microstomia can cause esthetic and functional problems. CASE REPORTS: Two cases are presented of patients with severe midfacial hypoplasia and reduced oral function as a result of treatment of rhabdomyosarcoma of the nasopharyngeal and nasal-tonsil region. With a combined surgical (osteotomy, distraction osteogenesis, implants) and prosthetic (implant-based overdenture) treatment, esthetics and function were improved.

Treatment outcome of two adjacent implant crowns with different implant platform designs in the aesthetic zone: a 1-year randomized clinical trial.

AIM: To evaluate the peri-implant tissues in patients with two adjacent implant crowns in the aesthetic zone, treated with either two adjacent implants with a scalloped platform or with a flat platform. MATERIAL AND METHODS: Forty patients were randomly allocated to: (1) a "scalloped implant group": 20 patients treated with two adjacent implants with a scalloped platform, and (2) a "flat implant group": 20 patients treated with two adjacent implants with a flat platform. Clinical and radiographic examinations were performed during a 1-year follow-up period to assess hard and soft tissue changes. RESULTS: The scalloped implant group showed significantly more marginal bone loss (scalloped: 2.7±1.4 mm, flat: 0.9±0.8 mm) and more inter-implant bone crest loss (scalloped: 1.8±1.4, flat: 1.0±0.9 mm) than the flat implant group. There was no significant difference between the groups with regard to the papilla index and patients' satisfaction. CONCLUSION: After 1 year of function, there was more bone loss around scalloped implants than around flat implants. With regard to the presence of papilla, there were no differences between the groups. With both applied implant designs, it is difficult to establish a predictable and harmonious aesthetic result, especially regarding the peri-implant mucosa. Patients were very satisfied with the aesthetic outcome of the adjacent implants irrespective of the treatment concept applied.

Immediate non-occlusal loading of single implants in the aesthetic zone: a randomized clinical trial.

AIM: this study compared the outcome of immediate non-occlusal loading with conventional loading for single implants in the maxillary aesthetic zone. It was hypothesized that immediate non-occlusal loading is not inferior to conventional loading. MATERIALS AND METHODS: sixty-two patients with a missing maxillary anterior tooth were randomly assigned to be treated with an implant that was either restored with a non-occluding temporary crown within 24 h after implant placement (the "immediate group") or was restored according to a two-stage procedure after 3 months (the "conventional group"). All implants were installed in healed sites. Follow-up visits were conducted after 6 and 18 months post-implant placement. Outcome measures were radiographic marginal bone-level changes, survival, soft tissue aspects (probing depth, plaque, bleeding, soft tissue level), aesthetics and patient satisfaction. RESULTS: no significant differences were found between both study groups regarding marginal bone loss (immediate group 0.91 ± 0.61 mm, conventional group 0.90 ± 0.57 mm), survival (immediate group 96.8%: one implant lost, conventional group 100%), soft tissue aspects, aesthetic outcome and patient satisfaction. CONCLUSION: within the limitations of this study (sample size, follow-up duration), it was demonstrated that, for single implants in the anterior maxilla, the outcome of immediate non-occlusal loading was not less favourable than conventional loading.

Trauma to an implant-supported crown that was saved by the fixation screw: a case report.

A traumatic impact to an implant-supported crown might damage the implant, restoration and peri-implant tissues. Ideally, only a small prosthetic retreatment is needed for restoration, as complicated prosthetic retreatments or surgical retreatments in particular, could be very inconvenient for the patient. However, there is a deficiency in literature on how the implant, restoration and surrounding tissues generally react to impact forces. This report demonstrates a case of trauma to an implant-supported crown in the maxillary anterior zone resulting in a displacement of the implant crown. After careful examination and follow-up, it appeared that only the fixation screw was damaged, whereas the implant, restoration and peri-implant tissues remained unharmed. Thanks to the protective qualities of the implant system, an easy prosthetic retreatment could restore the implant-supported crown and a surgical retreatment was prevented.

Treatment outcome and patient satisfaction with two adjacent implant-supported restorations in the esthetic zone.

The purpose of this study was to evaluate the clinical and radiographic parameters as well as the esthetic outcome of two adjacent implant-supported restorations and the surrounding peri-implant mucosa in the maxillary esthetic zone. Ten patients were treated with two adjacent implants in the anterior maxillary zone according to the same protocol. Only patients who had been subjected to a separate previous augmentation procedure with autogenous bone were included in this study. The following parameters were analyzed: implant survival, marginal bone level, vertical distance between the contact point and the bone crest, Papilla Index, probing depth, Aesthetic Index, and patient satisfaction. Implant survival was 100%. The interimplant bone crest level was positioned significantly more apical than the bone crest level between the implant and its neighboring tooth. In addition, complete filling of the interproximal space was observed between two adjacent implant-supported restorations in only 1 of 10 patients, whereas the papilla between the implant and its neighboring natural tooth was present in 70% of patients. Furthermore, patients rated the esthetic outcome of their implant-supported restorations and the surrounding mucosa in all cases as "acceptable," while the clinicians, using the Implant Crown Aesthetic Index, determined six to be "acceptable" and four "unacceptable." Although many patients were satisfied with the esthetic result, it is difficult to establish an acceptable esthetic result with two adjacent implant-supported restorations in the esthetic zone in patients who needed a separate augmentation procedure, according to the contemporary standards of dental professionals.

Immediate loading and customized restoration of a single implant in the maxillary esthetic zone: a clinical report.

The replacement of a single missing anterior tooth with an implant-supported crown is a demanding therapy. This report describes a treatment in which an anterior maxillary implant was immediately restored with a provisional restoration. During the provisional phase, an optimal emergence profile was created by adjusting the provisional restoration. An impression was made with an individually fabricated impression post for an accurate reproduction of the established emergence profile and, finally, a screw-retained all-ceramic crown was placed. By implementing this protocol, an optimal definitive result could be achieved, together with immediate patient satisfaction. However, cooperation among several disciplines and careful patient selection were required.

Vertical distraction of the severely resorbed edentulous mandible: an assessment of treatment outcome.

PURPOSE: To assess the treatment outcome (implant survival, surgical complications, patient satisfaction) of vertical distraction of the severely resorbed edentulous mandible. MATERIALS AND METHODS: Forty-six patients with severe resorption of the edentulous mandible (bone height 5 to 8 mm, median 6 mm) participated in this study. The anterior segment of the mandible was vertically augmented using the Groningen distraction device. One or 2 months after the last day of distraction, 2 implants (n = 92) were placed. Standardized clinical and radiographic assessments were performed annually, and patient satisfaction was scored on a 10-point rating scale (0 = completely dissatisfied; 10 = completely satisfied). RESULTS: Three implants were lost during the healing phase, but none were lost for the rest of the follow-up period (72 +/- 10.3 months), resulting in an implant survival rate of 97%. One patient developed a fracture of the mandible 3 days after the last day of distraction; it healed uneventfully. The mean mandibular bone resorption during follow-up as measured on radiographs in the midline and distal of the implants was 9.8% +/- 0.6% and 10.2% +/- 0.8%, respectively. In 4 patients radiolucency in the distracted area persisted during the follow-up period. Four patients reported a slight sensory disturbance at the final evaluation visit. All patients functioned well with their prostheses. The mean patient satisfaction score after treatment was 8.1 +/- 1.2. CONCLUSION: Vertical distraction of the anterior segment of a severely resorbed alveolar ridge of the mandible can provide a proper basis for insertion and osseointegration of endosseous load-bearing implants with good implant survival, few surgical complications, and good patient satisfaction.

Evaluation of aesthetics of implant-supported single-tooth replacements using different bone augmentation procedures: a prospective randomized clinical study.

OBJECTIVES: The aim of this study was to evaluate the aesthetics of implant-supported single-tooth replacements using different augmentation procedures in a prospective study with the use of an objective rating index and with a subjective patient questionnaire, and to compare the results with each other. MATERIAL AND METHODS: Ninety-three patients with a single-tooth gap in the anterior zone of the maxilla were selected for the study. All patients had a local bone defect that needed augmentation before placement of an endosseous implant with sufficient initial stability. Aesthetics of the implant-supported crown and adjacent mucosa was rated by a prosthodontist 1 year after placement of the porcelain crown. Aesthetics was rated using the Implant Crown Aesthetic Index. A subjective appreciation of the final result was assessed with a patient questionnaire. RESULTS: The Implant Crown Aesthetic Index reveals a mean overall score of 4.8, with an acceptable result in 66% of the cases. Results of the satisfaction questionnaire reveal a mean overall score of 8.5 with an acceptable result in 100% of the cases. There is no correlation between results of the Index and the questionnaire for the overall and the crown score. The patients' opinion and the professionals' opinion about the peri-implant mucosa do show a significant correlation. CONCLUSIONS: The peri-implant mucosa is rated as less satisfactory than the implant-supported crown by both the dental professional and patients. The dental professional was less satisfied with respect to the total result and results of the crown than the patients.

A new index for rating aesthetics of implant-supported single crowns and adjacent soft tissues--the Implant Crown Aesthetic Index.

OBJECTIVES: The important item of aesthetics is rarely included in evaluation studies. The aim of this study was to develop and validate an index for rating aesthetics of implant-supported single crowns and adjacent soft tissues. MATERIAL AND METHODS: Nine items were selected, which have an influence on the aesthetic result. The items are based on the anatomic form, colour and surface characteristics of the crown and on the anatomic form, colour and surface characteristics of the peri-implant soft tissues. Two oral-maxillofacial surgeons and two prosthodontists rated 24 implant-supported single-tooth restorations and adjacent soft tissues on a form with the nine items of the rating index. The rating was carried out twice by each of the examiners. Weighted Cohen's kappa was calculated to express the intra- and interobserver agreement. RESULTS: Intraobserver results indicated that the agreement between the first and second rating of both the prosthodontists was good (both 0.7) and that the agreement of the oral-maxillofacial surgeons was moderate (0.49 and 0.56). The best interobserver agreement was found between the two prosthodontists (0.61, good agreement). CONCLUSIONS: The Implant Crown Aesthetic Index is an objective tool in rating aesthetics of implant-supported single crowns and adjacent soft tissues. The rating is best be carried out by one prosthodontist to have the highest reliability.

Effect of an intraoral retrusion plate on maxillary arch dimensions in complete bilateral cleft lip and palate patients.

OBJECTIVE: The aim of this study was to analyze maxillary arch dimensions in patients with complete bilateral cleft lip and palate treated with an intraoral retrusion plate prior to lip closure. PATIENTS: The effects of the intraoral retrusion plate were evaluated on serially obtained maxillary casts of 14 patients with complete bilateral cleft lip and palate. RESULTS: The Student's t test for dependent observations showed a significant decrease in distance between the premaxilla and the cleft lateral segments during active treatment. This decrease correlated with an increase in deviation of the premaxilla in relation to the vomer. For each millimeter decrease in distance between the premaxilla and the cleft lateral segments, an average increase in deviation of 4.0 degrees was found. Left and right cleft widths decreased significantly, premaxillary width increased significantly, and transverse dimensions did not change significantly. CONCLUSION: From this study it can be concluded that active presurgical treatment with an intraoral retrusion plate induces a significant decrease in distance between the premaxilla and the lateral segments. This decrease is frequently accompanied by an increase in deviation of the premaxilla relative to the vomer.

The extremely resorbed mandible: a comparative prospective study of 2-year results with 3 treatment strategies.

PURPOSE: The aim of this prospective clinical study was to compare the clinical and radiographic results of 3 modes of implant treatment in combination with an overdenture in patients with extremely resorbed mandibles. The 3 treatment strategies used were a transmandibular implant, augmentation of the mandible with an autologous bone graft followed by placement of 4 endosseous implants, and the placement of 4 endosseous implants only. MATERIALS AND METHODS: Sixty edentulous patients met the inclusion criteria and were assigned according to a balanced allocation method to 1 of the 3 groups. Postoperative complications, implant survival, periodontal indices, change in mandibular bone height, and prosthetic complications were assessed during a 2-year evaluation period. RESULTS: During the evaluation period significantly more implants were lost in the transmandibular implant and the augmentation groups compared to the group with endosseous implants only. Except for the Bleeding Index and the Periotest values, the periodontal parameters did not differ significantly among the groups. In all 3 groups, there was no significant bone loss at most locations. Minimal prosthetic retreatment was necessary. DISCUSSION: Although implant loss is a frequently used outcome measure for success, the necessity of retreatment seems to be of more relevance for both the patient and the clinician. CONCLUSIONS: The results of this study suggested that patients with extremely resorbed mandibles can be treated with implants alone in this patient population.

Satisfaction and psychosocial aspects of patients with an extremely resorbed mandible treated with implant-retained overdentures. A prospective, comparative study.

The objective of the present report was to study the effect of implant treatment on subjective parameters in edentulous patients with an extremely resorbed mandible. Three different treatment modalities to support an overdenture were compared: transmandibular implant according to Bosker, augmentation of the mandible followed by four endosseous implants, and the insertion of four short endosseous implants. Sixty patients [50 women and 10 men, mean (+/- SD) age 59 (+/- 11) years] met the inclusion criteria and were assigned in one of the three treatment groups. Before treatment and 12 months after placement of the new overdentures, denture satisfaction, psychosocial aspects and experiences during the surgical phase were assessed with a battery of questionnaires. After 1 year, 58 patients were available for evaluation: one patient had died, and one patient had moved out of the region. There was a significant improvement of patient satisfaction and psychosocial functioning in all three treatment groups. At the 1-year evaluation, differences amongst the three groups were not significant. However, in terms of discomfort and pain during the surgical phase as well as the length of this phase (at least 6 months), the augmentation using an autologous bone graft from the iliac crest followed by inserting four endosseous implants 3 months later appeared the least favorite option of the three modalities studied.

Early loading of endosseous implants in the augmented maxilla: a 1-year prospective study.

In 10 patients, 68 endosseous implants were inserted in the augmented edentulous maxilla using a one-stage implant placement technique. Three months before implant insertion, the width and height of the alveolar crest were augmented with autologous bone grafts from the iliac crest. In all cases, the resulting bone volume was sufficient for implant insertion. According to an early loading protocol, the implant-supported overdenture was fabricated 2 months after insertion of the implants. Evaluation was performed according to a standardised protocol immediately and 1 year after fabrication of the prosthetic construction. The protocol included assessment of both clinical (bleeding score, pocket depth, implant mobility) and radiographic (marginal bone level on standardised radiographs) parameters. Three implants in two patients in the upper jaw were lost (survival rate: 95.6%). The peri-implant tissues had a healthy appearance and bone loss was minimal. Overall, the patients were very satisfied with the prosthetic construction. From this preliminary study, it is concluded that in selected cases, early loading of implants may develop into a predictable treatment modality after augmentation of the maxilla.