Rehabilitation of edentulous mandibles following the Brånemark Novum immediate loading protocol. A 21-Year Case Series Follow-up

Aim The purpose of the present research was to evaluate the clinical outcomes of edentulous mandibles rehabilitated using the Brånemark Novum protocol with 21-year follow-up. Material and Methods Between April and November 2001, four patients (3 men, 1 woman) were rehabilitated with fixed full-arch prostheses supported by three immediately loaded implants following the Brånemark Novum protocol. The main clinical outcomes evaluated were: peri-implant bone resorption (BR), cumulative implant survival rate (iCSR), and cumulative prosthetic survival rate (pCSR). The following parametres were also evaluated: probing depth (PD), bleeding on probing (BOP), plaque index (PI), and implant stability (expressed through implant stability quotient (ISQ) assessed by resonance frequency analysis (RFA)), and were evaluated over time, up to the 21-year follow-up. Results At the 21- year follow-up, one drop-out occurred as one patient died. Over the 21 years, no implant failed (iCSR 100%) and no prosthesis was replaced (pCSR 100%). In the period between the 16- and 21-year follow-up, bone level (mean BR: 2.45 mm at 21 years) and RFA values remained stable. At the 21-year follow-up, the implants had high PI values(83.3%)butlowBOPvalues(13.9%).MeanPDwas3.30mm(range: 2.5 to 4.5 mm). A biological complication was detected on a central implant (bone resorption with crateriform defect) but did not worsen between the 16th and 21st year of follow-up. Numerous prosthodontic complications (resin or tooth fractures) occurred over the 21 years; however, they were mostly recorded in the same parafunctional patient. Conclusion This is the first study reporting the outcomes of the Brånemark Novum protocol with a 21-year follow-up and shows excellent clinical results in the long term. The protocol has now been abandoned for his rigidity and difficulty in application, but it had the merit of indicating the key factors that can lead to predictability of the success in full-arch immediate loading rehabilitations.