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Getting started with immediate solutions - from single restoration to full arch

Beyond faster time-to-teeth

Nobel Biocare continues to innovate in the area of immediate solutions by offering surgical and prosthetic innovations that encourage primary stability and long-term tissue health. If you want to find out more about the immediate protocol, this webpage should help you better understand its key concepts and benefits.

A brief history of immediate implants

Prior to the introduction of immediate placement, the only widely accepted implant placement technique was the Brånemark protocol. In the beginning, immediate placement, provisionalization and loading were first proposed as ways to shorten time-to-teeth. The first reported immediate implant placed in a fresh extraction socket was performed by W. Schulte and G. Heimke in 1976. These researchers were also the first to describe the technique as a new form of therapy.1 Since then, numerous studies have touted the benefits of immediate placement, especially in terms of high survival rates across a range of indications.2-7

What is immediate placement and immediate provisionalization?

When a tooth is extracted and an implant is placed in the socket during the same appointment, this is known as “immediate placement.” If a temporary prosthesis is added within 48 hours, this is often referred to as “immediate provisionalization.”

Why the immediate protocol?

Let’s answer the question of why you would choose immediate provisionalization and loading. Ultimately, the question comes down to the preservation and long-term health of hard and soft tissues.9 Although, there are several additional benefits that make this protocol attractive to clinicians and patients.

Patients prefer complete dentition

Since a provisional restoration is provided within 48 hours, patients often appreciate immediate implant placement and provisionalization, as they do not have to go for an extended period with gaps in their dentition.10 A 2014 questionnaire-based interview study found a majority of patients receiving an implant in the anterior maxilla preferred immediate placement and loading over the four other treatment protocols offered.11

Click on the + signs to see more clinical benefits.

Smiling patient

Better marginal bone maintenance

A systematic review showed immediately loaded implants demonstrated slightly better marginal bone maintenance (0.1 mm) in comparison to conventionally loaded implants (P=0.03).12

Less midfacial recession

In a randomized clinical study that saw 49 patients receive 49 implants, the immediate and delayed restoration groups were compared. The findings showed a mean 0.75 mm less midfacial recession in the group with immediate provisionalization (2.5 – 3 times higher with conventional loading (P=0.005)). Patients with delayed loading took a full additional year to regain papilla height comparable to the immediate loading group.13

Soft tissue improvements

Immediate placement and function have shown to enhance soft tissues in the esthetic zone.14This indicates Immediate Function can lead to subtle improvements in comparison to delayed function.

Why choose Nobel Biocare for immediate cases?

Clinicians trust Nobel Biocare for immediate cases. They understand precision-engineered implants are essential to high survival, esthetics and ultimately patient satisfaction. By offering patients Nobel Biocare implants for immediate cases, clinicians can expect shorter treatment times, increased patient flow, reduced chair time, fewer visits and reduced overall costs. Nobel Biocare has an established track record for designing dental implants with high primary stability – a requirement for success in immediate cases. Several long-term studies with 5- to 10-year follow-ups have demonstrated high cumulative survival rates (97% – 100%) for Nobel Biocare's immediate load implants in extraction sites across a range of indications.15-16

Immediate placement implants

Nobel Biocare’s immediate solutions - from single restoration to full arch

  • Immediate implants

    Full portfolio of immediate implants

    Nobel Biocare offers a full portfolio of dental implants indicated for use in immediate cases. These include popular implants such as NobelActive®, NobelParallel™ CC and NobelReplace® CC, all of which are designed to promote primary stability, optimal osseointegration and esthetics. These implants are joined by the recently released Nobel Biocare N1™ system. The N1 system is a next generation implant system that allows for less traumatic site preparation, enhanced osteogenesis and remarkable soft tissue maintenance.18, 19

  • NobelZygoma implants

    Zygoma implants

    Zygoma implants can be immediately restored in severely atrophic maxillae without the need for grafting. Nobel Biocare offers zygoma implants in a number of lengths to cover a wide range of indications.

  • All on 4 treatment concept

    All-on-4® treatment concept

    The All-on-4® treatment concept provides patients with a fixed full-arch bridge on the same day as surgery. With this protocol, there are two straight anterior implants and two implants tilted up to 45º in the posterior. These implants can be loaded for Immediate Function if certain criteria are met, such as sufficient primary stability. The All-on-4® treatment concept foregoes bone grafting by tilting the posterior implants to better utilize available bone.

  • TempShell

    TempShell

    TempShell is a screw-retained CAD/CAM provisional with a natural esthetic that is delivered on the same day of surgery. This allows faster time to teeth and makes it possible for a patient to leave with a tooth in minimal appointments.17 TempShell is easy to adjust according to the implant position, minimizing the need for chairside adjustments.17

  • Snap abutment

    The Temporary Snap Abutment is used in conjunction with TempShell to create the opportunity for immediate provisionalization. It also increases the ability to reduce healing time, enhance esthetic results and increase patient satisfaction.20  Nobel Biocare’s prosthetic workflows allow for easy temporization. This gives you the ability to offer patients the opportunity to leave your practice with a tooth.

  • creos xenogain collagen

    creos™ regenerative portfolio

    Set the foundation for long-term success with the creos portfolio of regenerative solutions. From allo- and xenograft materials, to collagen membranes and absorbable wound dressings, we strive to be the trusted regenerative partner for you and your patients.

Digital workflows support immediate protocols

Nobel Biocare’s digital workflows facilitate immediate protocols, especially in the esthetic zone. By integrating intraoral and CT scans, surgical and restorative aspects of the case can be clearly visualized. This allows clinicians to take a prosthetically driven approach to immediate placement and provisionalization. Digital workflows allow custom CAD/CAM temporary restorations to be created on the planned positions of the implants, ultimately leading to successful delivery of provisional restorations shortly after surgery.

Discover more about Nobel Biocare’s digital dentistry solutions
Digital dentistry

What clinicians are saying about Nobel Biocare’s immediate solutions

 
Dr. Joe Mehranfar, United States

“Safe, predictable, and cost-effective”

“Immediate loading increases the acceptance rate of patients”

 
Dr. Rubén Davó, Spain

Schedule a Lunch & Learn

Want to learn more about immediate placement, function and related topics? Schedule a Lunch & Learn session with your local Nobel Biocare sales representative. We’ll bring new ideas and lunch for you and your team!

Get started

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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. De Rouck T, Collys K, Wyn I, Cosyn J. Instant provisionalization of immediate single-tooth implants is essential to optimize esthetic treatment outcome.Clin Oral Implants Res. 2009;20:566-570.

10. Deporter DA. A prospective clinical study in humans of an endosseous dental implant partially covered with a powder-sintered porous coating: 3- to 4-year results. Int J Oral Maxillofac Implants 1996;11(1):87.

11. Hof M, Tepper G, Semo B, Arnhart C, Watzek G, Pommer B. Patients’ perspectives on dental implant and bone graft surgery: questionnaire-based interview survey. Clin Oral Implants Res. 2014 Jan; 25(1):42-5.

12. Esposito M, Grusovin MG, Polyzos IP, Felice P, Worthington HV. Interventions for replacing missing teeth: dental implants in fresh extraction sockets immediate, immediate-delayed and delayed implants. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.:CD005968.

13. Tan WL, Wong TL, Wong MC, Lang NP. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res. 2012Feb; 23 Suppl 5:1-21.

14. Kolinski ML, Cherry JE, McAllister BS, Parrish KD, Pumphrey DW, Schroering RL. Evaluation of a Variable-Thread Tapered Implant in Extraction Sites With Immediate Temporization: A 3-Year Multi-Center Clinical Study. J Periodontol 2014 Mar;85(3):386-94.

15. 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;14:565-74.

16. 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. Polizzi G, Cantoni T. Five-Year Follow-Up of Immediate Fixed Restorations of Maxillary Implants Inserted in Both Fresh Extraction and Healed Sites Using the NobelGuide™ System. Clin Implant Dent Relat Res 2013.

17. Pozzi A, Arcuri L, Moy PK. Temporary Shell Proof-of-Concept Technique: Digital-Assisted Workflow to Enable Customized Immediate Function in Two Visits in Partially Edentulous Patients. Compendium of Continuing Education in Dentistry (Jamesburg, NJ : 1995). 2018;39(3):e9-e12. Read on PubMed

18. Chen CH, Coyac BR, Arioka M, et al. A Novel Osteotomy Preparation Technique to Preserve Implant Site Viability and Enhance Osteogenesis. J Clin Med. 2019;8(2):1-13. 

19. Velikov S, Susin C, Heuberger P, Irastorza-Landa A. A New Site Preparation Protocol That Supports Bone Quality Evaluation and Provides Predictable Implant Insertion Torque. J Clin Med. 2020;9(2).

20. Kolinski ML, Cherry JE, McAllister BS, et al. Evaluation of a variable-thread tapered implant in extraction sites with immediate temporization: a 3-year multicenter clinical study. J Periodontol 2014;85(3):386-394.