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The Evolution of AnyTime Loading: Dr. Heo’s Exploration of Immediate Loading Implants
The journey towards AnyTime Loading began with the exploration of Immediate Loading, a concept scrutinized and refined over decades. Dr. Youngku Heo focused on the evolution and success of “AnyTime Loading” based on his extensive 20-year clinical experience.
"I am a prosthodontist who wants to finish prostheses as soon as possible. I don’t want to wait until implants are fully osseointegrated. But I still want to get 100% success! How is it possible?" - Dr. Youngku Heo
As a prosthodontist, Dr. Heo prefers immediate loading to expedite the prosthetic process without compromising success rates.
Dr. Tarnow's 1995 lecture: A Milestone in Immediate Loading Implants
In 1995, Dr. Dennis Tarnow gave a lecture on immediate loading, and Dr. Heo was shocked by the findings presented.
Conventionally, implant surgery required a waiting period for osseointegration before loading the prosthesis. This cautious approach aimed to minimize the risk of implant failure. However, Dr. Tarnow's research suggested that the success rate of immediate loading, without waiting for osseointegration, was comparably high.
In his study, Dr. Tarnow placed 9 implants in the mandibles of his patients. 4 of these implants were submerged, and the remaining 5 implants were immediately loaded on the day of surgery. The results were astonishing. 5-year clinical results showed no significant difference in success rates between submerged and immediately loaded implants, both achieving a 97% success rate.
Dr. Tarnow proposed specific guidelines for clinical success of Immediate Loading on those studies.
Use of screw-type implants
Implants with a rough surface (TPS)
Broad base tripod placement
Rigid bilateral cross-arch splinting
Dr. Heo’s 1998 Study: Predictability and Success of Immediate Loading Implants for Full-Arch Fixed Bridges
In 1998, Dr. Heo conducted a groundbreaking study at Catholic University that confirmed the predictability and success of immediate loading for full-arch fixed bridges.
Dr. Heo's method involved extracting all teeth in the lower jaw and placing 5 implants. Within one week, he fabricated a cross-arch splinted provisional restoration to ensure stability and immediate function. This quick turnaround was essential in providing patients with functional and aesthetic results without the extended waiting periods.
The definitive prostheses were delivered within three months. Remarkably, even 15 years later, the implants and restorations remained perfectly maintained, showcasing the long-term success and durability of this immediate loading approach.
Dr. Heo's study demonstrated that immediate loading with a full-arch fixed bridge is highly predictable and effective.
Dr. Heo’s 2000 Study: Immediate Loading Implants in Partially Edentulous Cases
In 2000, Dr. Heo embarked on a pioneering study to explore the feasibility of immediate loading in partially edentulous cases, an area that had seen little research at the time. His approach involved conducting animal experiments to validate this concept, given the lack of existing studies.
Dr. Heo's research utilized 24 Branemark implants placed in 4 beagle dogs. Each dog had 3 implants on both the left and right sides of their jaws. The implants on the left side were left non-splinted, while those on the right side were splinted together.
The results were remarkable, achieving an overall success rate of 87%. Although 3 implants failed (2 non-splinted and 1 splinted), there were no statistically significant differences between the splinted and non-splinted groups. This outcome was particularly impressive considering the dogs exerted substantial lateral force during mastication, which could have compromised the implants' stability.
Dr. Heo's 1998-2003 Clinical Study: Insights into Immediate and Early Loading Implant Success
From 1998 to 2003, Dr. Heo conducted a comprehensive 5-year prospective clinical study focusing on immediate and early loading of dental implants. This study involved 384 implants placed in 118 patients, categorized into 4 distinct groups(Full Arch, Anterior Multiple, Posterior Multiple, Single).
The results were impressive, with an overall success rate of 91.4%. The success rates by group was as follows:
The findings highlighted that the cross-arch splinted group exhibited the highest survival rate. And the linear splinted posterior group also demonstrated a high survival rate. However, the single crown group had the lowest success rate.
The primary reasons for the lower success rate in the single crown group were:
Lack of stabilization due to the single implant
Difficulty in managing to prevent overload
Overload leading to micromotion exceeding 50-100μm, which significantly increases the risk of osseointegration failure.
Insights from Dr. Heo’s Studies: Immobilization as the Key Factor for Successful Osseointegration
In these studies, Dr. Heo concluded that immobilization, rather than loading time, is the key factor for successful osseointegration. Maintaining the immobilization of loaded implants within 50μm is vital for achieving optimal results. For Immediate Loading and Early Loading, achieving optimal insertion torque, ensuring stabilization of the implants, and preventing micromotion are crucial factors.
These studies underscore the importance of stability and immobilization in dental implant success, paving the way for advancements in implant techniques and protocols.
Essential Innovations for Successful Osseointegration by Dr. Heo and Neobiotech
For successful osseointegration, Dr. Heo’s research has provided several solutions:
Prosthetic Design: Creating prosthetic designs that minimize lateral forces, which are primarily exerted during mastication, is essential. This helps reduce the risk of micromotion that can compromise the stability of the implant.
Implant Design and Drilling Protocol: Neobiotech has developed advanced implant designs and drilling protocols. These innovations ensure that implants remain stable and immobile, crucial factors for successful osseointegration.
To enhance implant stability, Neobiotech has consistently devoted significant effort to innovations:
[2006] CMI Implants
Since 2006, Neobiotech has made great efforts to design implants for AnyTime loading. The CMI Implant features a very aggressive and tapered shape with powerful magic threads, designed to achieve good fixation in soft bone.
[2008] SCA Kit & Technique
SCA Technique is sinus crestal approach with drilling at high speed in the sinus but without membrane tearing. It’s dedicated not only to sinus lifting but also to achieving good fixation from the inferior cortical wall of the sinus.
[2008] CMI Fixation
CMI Fixation concept aims to achieve optimal initial stability in varying clinical situations with different bone height and quality. By dividing the implant into three zones(C for the coronal part, M for the middle part, and I for the apical part), the concept guides clinicians to obtain fixation from every part of the implant in various bone situations.
The CMI Implant, SCA Technique & Kit, and CMI Fixation were all developed to achieve optimal fixation, enhance stability, and ensure successful osseointegration. These innovations have been dedicated to enable implants to perform reliably in diverse clinical scenarios, ultimately providing better outcomes for patients.
In this post, we talked about the evolution of the AnyTime Loading concept, which began with the exploration of immediate loading, and the various products developed for this purpose. In the next post, we will learn about how CMI Implant is an optimized design to achieve optimal fixation, along with various case studies.