Objectives: The aim of the present systematic literature review was to determine whether long‐term treatment results with single‐tooth implants may differ depending on the timing of implant placement in relation to tooth extraction (immediate IP/early EP/delayed DP) and the timing of prosthetic loading (immediate IL/early EL/delayed DL).Material and Methods: Electronic and manual searches were performed to identify studies reporting on long‐term results (survival rate and/or marginal bone resorption after ≥3 years) of maxillary single‐tooth implants in the aesthetic zone using defined placement and loading protocols. Comparative trials were subjected to meta‐analyses whilst data from single‐arm studies were pooled to evaluate differences between timing protocols.Results: A total of 7 controlled trials were considered for meta‐analyses: immediate loading was compared to delayed loading in 3 studies on immediate placement (IPIL vs. IPDL, p = .306) and in 2 studies on delayed placement (DPIL vs. DPDL, p = 1.000) whilst 2 studies compared early versus delayed placement with delayed loading (EPDL vs. DPDL, p = .600), however, without significant differences. Pooled data analysis of 29 studies (965 implants) did not show differences between timing of placement or loading as well as marginal bone remodelling. No impact of the one abutment – one time concept, flap design and simultaneous bone or soft tissue augmentation could be established.Conclusions: Insufficient data are available for meta‐analytic comparison of all combinations of implant placement and loading protocols.

Objective: To investigate the impact of timing of implant placement and loading on implant survival and biological outcomes of multiple‐unit implant‐supported fixed dental prosthesis (FDPs).Material and Methods: A literature search was performed by three independent reviewers for studies reporting on ≥10 patients with FPDs supported by ≥two implants over ≥3 years of follow‐up. Data were analyzed on implant survival and biological complications as primary outcomes and biological events, including changes in peri‐implant marginal bone level (MBL), probing depth, soft‐tissue level, and health condition as secondary outcomes.Results: 7002 titles were identified, 360 full‐texts were screened, and 14 studies were included. These comprised 6 randomized controlled studies (RCTs), 5 cohort studies, and 3 case series with identifiable implant placement and loading protocols in five of 09 possible combinations. All groups but one (IPIL) showed implant survival rates >90%. A meta‐analysis based on 3 RCTs found no differences in survival rate between DPIL and DPDL (p = .227).Conclusions: High survival rates for all studied implant placement and loading combinations were shown for FPDs over ≥3 years of follow‐up. When a delayed implant placement protocol is applied, immediate or delayed loading demonstrated similar survival rates. The heterogeneity of the data did not allow to draw any further conclusions on the occurrence of biological complications related to timing of implant placement/loading.

Restorative material selection has become increasingly challenging due to the speed of new developments in the field of dental material science. The present narrative review gives an overview of the current indications for implant abutments and restoration materials for provisional and definitive implant‐supported fixed dental prostheses in partially edentulous patients. For single implant restorations, titanium base abutments for crowns are suggested as an alternative to the conventional stock‐ and customized abutments made out of metal or zirconia. They combine the mechanical stability of a metallic connection with the esthetic potential of ceramics. For multiple‐unit restorations, conical titanium bases especially designed for bridges are recommended, to compensate for deviating implant insertion axes and angulations. Even though titanium base abutments with different geometries and heights are available, certain clinical scenarios still benefit from customized titanium abutments. Indications for the definitive material in fixed implant restorations depend on the region of tooth replacement. In the posterior (not esthetically critical) zone, ceramics such as zirconia (3–5‐Ymol%) and lithium‐disilicate are recommended to be used in a monolithic fashion. In the anterior sector, ceramic restorations may be buccally micro‐veneered for an optimal esthetic appearance. Lithium‐disilicate is only recommended for single‐crowns, while zirconia (3–5‐Ymol%) is also recommended for multiple‐unit and cantilever restorations. Attention must be given to the specific mechanical properties of different types of zirconia, as some feature reduced mechanical strengths and are therefore not indicated for all regions and restoration span lengths. Metal‐ceramics remain an option, especially for cantilever restorations.