Patient- and Clinician-Reported Outcomes and Outcome Measures Evaluating Timing of Implant Loading in the Edentulous Maxilla: A Systematic Review of Prospective Studies.

AIM: To identify patient-reported outcomes (PROs) and clinician-reported outcomes (ClinROs) and their outcome measures (PROMs and CROMs) used in prospective studies comparing immediate, early, and delayed implant loading protocols in edentulous maxilla patients receiving implant-supported prostheses.

MATERIALS AND

METHODS

Protocol-driven electronic searches were conducted across MEDLINE, Embase, Scopus, Web of Science, Cochrane databases-January 2014 to May 2024-to identify prospective interventional and observational studies comparing immediate, early, delayed implant loading in maxillary edentulous patients. Zygomatic implants were excluded. Risk of bias was performed using Cochrane RoB 2 and ROBINS-I, and results were reported descriptively.

RESULTS

Five studies were included, of which four compared immediate versus delayed loading and one study compared immediate versus early loading. PROMs like visual analog scale (VAS) tool (reported in 80%) to evaluate 7 PROs: pain, overall satisfaction, comfort, speech, masticatory function, esthetics, and self-esteem. Three studies reported Oral Health Impact Profile (OHIP-19, OHIP-20), McGill Pain Questionnaire, and condition-specific instruments assessing two outcomes: chewing ability and muscular activity during oral functions. ClinROs varied considerably between studies, demonstrating significant methodological diversity. ClinROs included implant stability, accuracy, occlusal parameters, periodontal health metrics, surgical outcomes, and esthetic evaluation via VAS.

CONCLUSION

PROs were predominantly assessed using VAS to evaluate patient satisfaction, pain, function, and esthetics, followed by the OHIP Questionnaire for quality-of-life assessment in immediate versus early/delayed loading protocols. ClinROs showed no standardized approach, creating significant heterogeneity in the reported outcomes. Standardization of assessment methods and reporting of PROMs/CROMs is needed to optimize analyzing patient-centered outcomes.