What is immediate loading?
Over the last few decades, dental implants have become the first choice to replace missing teeth.
However, with old implant design, the assumption was that implant needs three to six months after its placement, bond to bone prior to its loading. This resulted in situations in which patients had to wear removable dental appliance, fixed partial denture or continue with missing teeth for a prolonged period of time, until the implant could be used.
In recent years, an increasing number of evidence-based studies, proved the actual predictability and success of a different approach, Known today as ‘immediate loading’, or “ Same Day Implant”.
What is immediate loading?
This process allows for the attachment of a temporary crown or bridge on the day of implant placement. This means your new teeth can be completed in just one trip. In doing so, it provides patients with an immediate aesthetic solution, and in many cases – a functional one too.
Although not indicated in all cases, clinical experience has shown that, given the right circumstances and clinical situations, utilizing the immediate loading protocol is often by far the best course of action. It is safe, effective and indicated in many cases.
What are the ‘right circumstances and clinical situations‘?
While surgical skill, experience and technique are the more obvious influencing factors, there are other important factors that dictate the outcome of a successful immediate loading implant procedure while minimizing risk. These include:
- Bone quality/quantity
- Implant’s primary stability
- Implant design, feature & surface
- Patient habits
Bone quantity and density are very important factors for correct position and stability of the implant. When bone grafting is needed, a delayed approach should be considered, instead of immediate implant placement. Similarly, in certain cases following teeth extractions, or when bone is too thin or lacks height, it may be preferable for the site to be grafted first. The immediate loading protocol can then be reassessed during the second surgical procedure.
Implant’s primary stability
Initial stability is the key factor that influence implant success, and is of utmost importance when making the decision to immediately load.
Although there are no scientifically approved parameters that determine what is considered to be ‘good stability’, one commonly accepted guideline is a placement torque of 35Ncm or higher. To achieve this level of stability, dentists may be required to alter the standard drilling protocols, choosing implants with a tapered shape and sharp thread designs, and planning a sound surgical technique for these cases.
As long as correct diagnosis and technique are utilized and an implant is properly stabilized, both research and evidence-based published data suggest that there is no difference in the success levels of immediate loading compared to that of a traditional implant placement approach.
Implant Design, Feature & Surface
Many implant designs are available nowadays, but specific features make some better than others when it comes to their ability to support immediate loading. Some of these features include:
- A tapered design that, when torqued into the bone, gently compresses the bone and thus achieves greater stability.
- Sharp threads at the apical aspect of the implant – allowing for maximum engagement into the bone; and less sharp threads at the cervical aspect of the implant – to ensure mild compression against the bone.
- Surface treatment that increases surface area, promotes fast healing and increases bone-to-implant contact.
Benefits of immediate loading dental implants
Immediate loading dental implants have many benefits compared to traditional implants. Not only can they be placed immediately after extraction, but this treatment is less painful than the traditional dental implants, and reduce the physiological bone loss, that normally occured after tooth extraction.
While bone quality, implant selection and operator skill are vital components in ensuring immediate loading success, it means nothing without complete patient cooperation.
Patients need to be fully committed to maintaining excellent oral hygiene, eating soft foods, preventing excessive forces on the implant-supported restoration and preventing harmful habits during the period of osseointegration, such as smoking…. If there is any doubt as to whether the patient can genuinely make that commitment, the dentist should think about preparing the patient for alternative treatment options.