Immediate loading: What’s in it for the patient and practice?
When appropriate, immediate implant placement and immediate implant loading offer an opportunity to shorten time-to-teeth and reduce the number of visits.
What is immediate implant placement?
Immediate implant placement is when an implant is placed at the same time as the natural tooth is extracted. Implant placement in fresh sockets was first reported by Schulte and Heimke in 1976, termed ‘immediate implant’.1 Over the years there have been many studies reporting high survival rates.2 The expert recommendations published for single implant placement following the Foundation for Oral Rehabilitation (FOR) consensus conference of October 7–8, 20153 were that careful patient selection, proper treatment planning, and precise implant placement were necessary to gain predictable and esthetic results.
What is immediate loading?
Immediate loading, otherwise known as Immediate Function, involves the placement of a restoration within 48 hours of implant placement.4 It can be applied if sufficient primary stability is achieved – for a single tooth restoration, this is known as immediate provisionalization.
The technique was developed in response to patients’ growing demand for quicker treatment and faster time-to-teeth. Ledermann was the first to document successful healing of immediately loaded implants,5 which were placed in the anterior part of the mandible, but Schnitman et al. were first to explore the possibility of successfully fixing a partial prosthesis to immediately loaded implants.6 Among the several long-term studies performed since then with 5-10 years’ follow-up, high cumulative survival rates, such as around 97% – 100% were reported for immediately loaded implants placed in extraction sites for any indication.7 To avoid loading a restoration, the provisional should be taken out of occlusion or the patient should be instructed to follow a soft diet.
Benefits to the patient and practice
In suitable cases, immediate placement and immediate loading offer an array of benefits for the patient, including shorter treatment time and significantly reduced time (if any) spent with a gap in the dentition since the esthetic restorations are provided on the day of surgery.8 Indeed, a 2014 study found that patients preferred immediate implant placement in the anterior maxilla, when compared to four other treatment protocols.9 It may therefore offer a suitable solution for high patient satisfaction, when clinically indicated.
Immediate implant placement and provisionalization have been used with good predictability in clinical practice.10 Immediate loading reduces the need for surgical intervention and complex bone grafting procedures that might otherwise be required to restore resorbed ridges. The one-stage technique offers a simplified surgical workflow and subjects the patient to one surgery instead of two. Improvements in patients’ post-operative experience following flapless approaches for single-tooth rehabilitation have been reported.11 Successful cases of the immediate loading protocol have also been reported for multiple implant placement.12
With close collaboration between oral surgeon, prosthodontist and lab technician, immediate implant placement and immediate loading can provide a unique selling proposition (USP). This can form an integral part of a marketing strategy, ensuring the practice is more attractive than others in the local vicinity, or even further afield.
Importance of choosing the right implant system
A clinically proven and well-researched dental implant system should be used to help ensure predictability and long-term success of immediate placement and loading. For single implant placement, NobelActive provides an expanding, tapered implant body that gradually condenses the bone as the drilling blades at the apex facilitate a smaller osteotomy.13 This enables the implant to achieve the high primary stability required to perform immediate placement and immediate loading, even in situations where it might otherwise be challenging – such in soft bone or extraction sockets.14
Fulfilling expectations
Patients want to be treated in an efficient and expedient manner. When seeking a solution, they want safe and effective treatment that can be performed in the shortest possible time and with as little pain and discomfort as possible. Immediate implant placement and loading are valuable techniques for the clinician to call upon, but their skill and experience, as well as case selection, are all crucial elements to ensure successful long-term results.
References
1. Schulte W, Heimke G. The Tübinger immediate implant. Quintessenz 1976; 27(6): 17-23.
2. Gelb DA: Immediate implant surgery: Three year retrospective evaluation of 50 consecutive cases. Int J Oral Maxillofac Implants 8:388, 1993.
Abt E. Growing body of evidence on survival rates of implant-supported fixed prostheses. Evidence-Based Dentistry (2008) 9, 51–52. doi:10.1038/sj.ebd.6400584.
Degidi M, Nardi D, Piattelli A. 10-year follow-up of immediately loaded implants with TiUnite porous anodized surface. Clin Implant Dent Relat Res 2012; 14(6): 828-838.
Mura P. Immediate loading of tapered implants placed in postextraction sockets: retrospective analysis of the 5-year clinical outcome. Clin Implant Dent Relat Res. 2012; 14(4): 565-574.
Becker W, Dahlin C, Lekholm U, Bergstrom C, van Steenberghe D, Higuchi K, et al. Five-year evaluation of implants placed at extraction and with dehiscences and fenestration defects augmented with ePTFE membranes: Results from a prospective multicenter study. Clin Implant Dent Relat Res 1999; 1(1): 27-32.
Polizzi G, Grunder U, Goené R, Hatano N, Henry P, Jackson WJ, et al. Immediate and delayed implant placement into extraction sockets: A 5-year report. Clin Implant Dent Relat Res 2000;2(2):93-9.
Weigl P, Strangio A. The impact of immediately placed and restored single-tooth implants on hard and soft tissues in the anterior maxilla. Eur J Oral Implantol. 2016;9 Suppl 1:S89-106.
3. Polizzi G, Grunder U, Goené R, Hatano N, Henry P, Jackson WJ, et al. Immediate and delayed implant placement into extraction sockets: A 5-year report. Clin Implant Dent Relat Res 2000;2(2):93-9.
4. Cochran DL, Morton D, Weber HP. Consensus statements and recommended clinical procedures regarding loading protocols for endosseous dental implants. Int J Oral Maxillofac Implants 2004;19(suppl):109–113.
5. Ledermann P. Bar-prosthetic management of the edentulous mandible by means of plasma-coated implantation with titanium screws [In German]. Deutsche Zahna¨rztliche Zeitschrift. 1979;34:907–911.
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13. Irinakis T, Wiebe C. Clinical evaluation of the NobelActive implant system; a case series of 107 consecutively placed implants and a review of the implant features. J Oral Implantol. 2009;35:283-88.
14. Cosyn J, De Bruyn H, Cleymaet R. Soft tissue preservation and pink aesthetics around single immediate implant restorations: A 1-year prospective study. Clin Implant Dent Relat Res. 2012.
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