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A clinical study on the 6-year outcomes of immediately loaded three implants for completely edentulous mandibles: “the all-on-3 concept”

  • Mustafa Ayna
  • Keyvan Sagheb
  • Ralf Gutwald
  • Henning Wieker
  • Christian Flörke
  • Yahya Açil
  • Jörg Wiltfang
  • Aydin GülsesEmail author
Original Article


The objective of the current study was to demonstrate the 6-year clinical and radiological treatment outcomes of the technique performed by immediately loading of three implants (single straight in the mid-line and two tilted distal implants) for the management of total edentulous mandibles and introduce a simple decision matrix for selection of the most appropriate protocol in cases with insufficient length of the interforaminal area. Re-assessments were performed over a total observation period of 6 years after surgery via measurement of bone resorption around implants, bleeding on probing, plaque accumulation, periodontal probing depth, bite force measurements and oral health impact profile. A total of 29 patients (45% women and 55% men) with a mean age of 65 ± 6 years enrolled in the study. 14 patients received an acryl-based bridge as definitive prosthetic restoration and 15 patients received a ceramic-based restoration. Both during the immediate loading phase and during the 6-year follow-up, there was no implantation loss. Regardless of the implant position, all implants showed continuous bone loss over the observation time. The bone loss around dental implants during observation period was only maximum 1.0 ± 1 mm and it remained well within the limits for ‘success’ according to the 2007 Pisa consensus (< 2 mm). The plaque index showed no significant fluctuations between the implant positions and the individual examination times. The approach described herein might help the surgeon by avoiding unnecessary loss of bone strength, selecting implant sites, and establishing the biomechanical advantage of increased A–P spread for immediate function.


Mandible Immediate loading Implant Tilted 



The authors would like to thank Eylem Ugur Gülses for conducting the statistical analysis of the manuscript.



Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Review Committee (NEAH/12.15.2015#498).

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© The Society of The Nippon Dental University 2019

Authors and Affiliations

  • Mustafa Ayna
    • 1
  • Keyvan Sagheb
    • 2
  • Ralf Gutwald
    • 3
  • Henning Wieker
    • 4
  • Christian Flörke
    • 4
  • Yahya Açil
    • 4
  • Jörg Wiltfang
    • 4
  • Aydin Gülses
    • 4
    • 5
    Email author
  1. 1.Center for Dental ImplantologyDuisburgGermany
  2. 2.Department of Oral and Maxillofacial SurgeryUniversity of MainzMainzGermany
  3. 3.Department of Oral and Maxillofacial SurgeryDanube Private UniversityDanubeAustria
  4. 4.Department of Oral and Maxillofacial SurgeryChristian Albrechts UniversityKielGermany
  5. 5.Department of Oral and Maxillofacial SurgeryChristian Albrechts University, UKSHKielGermany

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