Descbribes Factors involved in Immediate loading

1. Immediate loading
Presented by:
DR. KELLY NORTON
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2. CONTENTS:
• Introduction
• Definition
• Indications and contra-indications
• Advantages and disadvantages
• Rationale for immediate loading
• Diagnosis and treatment planning
• Completely edentulous patients
• Immediate loading with overdentures
• Partially edentulous patients.
• Single implant studies
• Risk of Immediate loading protocols
• Cross-References
• Conclusion
• References and Cross-References
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3. INTRODUCTION
• The introduction of osseointegrated implants in dentistry symbolizes a turning
point in clinical dental practice.
• Immediate loading (IL) of dental implants has recently gained popularity due to
several factors including reduction in treatment time and trauma as well as
aesthetic and psychological benefits to the patient.
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4. • The two-stage surgical protocol
established by Brånemark et al. to
accomplish osseointegration consisted of
the following guidelines:
 Countersinking the implant below the
crestal bone.
 Obtaining and maintaining a soft tissue
cover over the implants for 3-6 months.
 Maintaining a non-loaded environment
for 3-6 months.
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5. • The primary reasons cited for this submerged, countersunk
surgical approach to implant placement were:
 To minimize or reduce the risk of bacterial infection
 To prevent apical migration of oral epithelium along the
body of the implant
 To reduce & minimize the risk of early implant loading
during bone remodeling.
* Following this procedure, a second stage surgery is necessary
to uncover these implants and place a prosthetic abutment.
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6. • One stage or non-submerged approach has advocated
that, implants osseointegrate , even when they reside
above the bone & soft tissue during early healing and has
the following advantages:
1. Eliminates second stage surgery.
2. Tissue discomfort and healing associated with 2nd stage
surgery are eliminated.
3. Surgical time for suture removal and uncovering are
avoided.
4. Soft tissue is already mature before the fabrication of the
final prosthesis.
Immediate loading of a dental implant not only includes a
non-submerged one stage surgery, but also actually loads
the implant with a provisional restoration at the same
appointment.01-05-2018 670

7. DEFINITION
Immediate Restoration or /Occlusal Loading
(IOL)—
• immediate occlusal-loading protocol is an implant
supported temporary or definitive restoration in
occlusal contact within 2 weeks of the implant
insertion.
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Contemporary implant dentistry
Carl E. Misch 3rd Edition

8. Non functional early restoration:
• A restoration in a partially edentulous patient
delivered between 2 weeks and 3 months after
the implant insertion.
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Contemporary implant dentistry
Carl E. Misch 3rd Edition
Non functional immediate restoration:
• An implant prosthesis with no direct occlusal load
within 2 weeks of implant insertion and is
primarily considered in partially edentulous
patients.

9. Early occlusal Loading:
• An implant-supported restoration in occlusion between 2 weeks and 3
months after implant placement and may use the time period in
parentheses (i.e., early [5-week] occlusal loading).
Delayed loading/ staged occlusal loading:
• An implant prosthesis with an occlusal load after more than 3 months
after implant insertion.
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Contemporary implant dentistry
Carl E. Misch 3rd Edition

10. TIMING OF IMPLANT PLACEMENT
19 10Chen S, Buser D. Implants in post-extraction sites: A literature update. In: Buser D, Belser U, Wismeijer D (eds). ITI Treatment Guide.Vol 3: Implants in
extraction sockets. Berlin: Quintessence, 2008.

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http://glidewelldental.com/education/inclusive-dental-implant-magazine/volume-2-issue-2/the-immediate-loading-of-dental-implants/

12. INDICATIONS
• Adequate bone quality (Types I, II, or III)
• Sufficient bone height ( i.e. approximately
12mm ) for a minimum length of 10 mm
implant
• Sufficient bone width ( i.e. approximately 6
mm)
• Ability to achieve an adequate antero-
posterior spread between the implants.
• A poor AP spread decreases the mechanical
advantage gained by splinting and the ability
to cantilever the restoration
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13. CONTRAINDICATIONS
1. Poor systemic health
2. Severe parafunctional habits
3. Bone of poor quality
4. Bone height less than 12 mm
5. Bone width less than 6 mm
6. Inability to achieve an adequate
AP spread
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14. ADVANTAGES AND DISADVANTAGES OF IMMEDIATE
OCCLUSAL LOADING
Advantages:
1. Eliminates the need for and maintenance of a
removable provisional prosthesis
2. Provides emotional benefit for a patient scheduled
to be rendered edentulous
3. Improves bone healing
4. Facilitates soft tissue shaping
5. Eliminates premature implant exposure often
associated with wearing of a removable denture
during healing period.
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15. DISADVANTAGES:
• Micro-movement of implant that can cause crestal bone loss or
implant failure is greater than two stage procedure.
• Direct visual evaluation of crestal bone during 2nd stage surgery is lost.
• Parafunction from tongue or foreign bodies( Pen biting) may cause
trauma and crestal bone loss.
• Too soft bone, small implant diameters or implant designs with less
surface area, may cause too great crestal stress contours and cause
bone loss or implant failure.
• If immediate loading leads to failure of the implants, there may be
adjuvant bone loss, which may require additional bone grafting
procedures.
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RATIONALE FOR IMMEDIATE LOADING

17. (A)SURGICAL TRAUMA:
• Bone interface is stronger on the day of implant placement
compared with the time three months later.
• The surgical process of implant osteotomy preparation and
implant insertion, causes a regional acceleratory
phenomenon of bone repair around the implant interface.
• The implant bone interface is the weakest & most at risk of
overload at 3 to 6 weeks, due to bone remodeling at the
interface.
• Causes such as thermal injury & microfracture of bone, can
lead to osteonecrosis and fibrous encapsulation of the
implant.
• Heat generated may depend on the amount of bone
prepared, drill design and sharpness, depth of osteotomy,
irrigation and rpm of the drill.
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18. (B) BONE LOADING TRAUMA
• The woven bone of surgical trauma has been called repair bone
• The woven bone formed from a mechanical or loading response may be called reactive
woven bone
• Remodeling from mechanical strain or bone turnover, permits the repair of the bone after
trauma or allows the bone to respond to It’s local mechanical environment.
• Lamellar bone is organized, highly mineralized, is the strongest bone type, has the highest
modulus of elasticity -> Load Bearing Bone.
• Woven bone in comparison is unorganized, less mineralized, weaker, more flexible, though it
forms at a faster rate than lamellar bone.
• The rationale for immediate loading hence, is not only to minimize woven bone formation
or fibrous tissue formation, but also to promote lamellar bone maturation to sustain
occlusal load.
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19. HISTOLOGIC EVALUATION
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Histological studies by Randow et al. have suggested that
immediate loading may enhance bone remodeling and
further enhance bone density.
Short term study results show that immediately loading
of the implant does not necessarily place the interface at
the risk of fibrous tissue formation.
Long term study results showed that immediately loaded
implants exhibited twice the BIC compared to unloaded
implants.

20. IMMEDIATE OCCLUSAL LOADING FACTORS THAT DECREASE RISKS
(A) Bone Microstrain :
• Goal for an immediately loaded implant/ prosthesis
system is to decrease the risk of occlusal overload &
resultant increase in remodeling rate of the bone.
• One method to decrease microstrain & remodeling rate in
bone is to provide conditions that increase functional
area to the implant bone interface.
• The area of load may be increased by :
 Implant number
 Implant size
 Implant design
 Implant body surface conditions
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21. 1. IMPLANT NUMBER:
• The functional surface area for an occlusal
load at an implant interface can be
increased by increasing the number of
implants.
• The decrease in the number of pontics may
also decrease the risk of fracture of
transitional prosthesis, which could have
again be a source of overload to remaining
implants.
• maxilla : 8 - 12 implants
• mandible 5-9 implants are recommended.
• Increased number of implants may be
used, in case of reduced bone density in
either arches.
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22. 2. IMPLANT SIZE:
• Implant length is a more relevant factor in case of immediate
loading, especially in case of softer bone.
• For every 3mm increase in implant, the overall surface area will
increase by 20%.
• The additional implant length may also permit the implant to
engage the opposing cortical plate (bi-cortical stabilization),
which further increases implant initial stability.
• Width is more important for the crestal bone where the
occlusal stress are greatest.
• Major increase in tooth size occurs in the molar region where
the surface area is double than the rest of the dentition.
Therefore implant diameter is increased in the molar region.
• If increasing width is not possible, then bone grafting or
additional implants may be considered for replacing teeth.
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23. Do Longer Implants Improve Clinical Outcome In Immediate Loading?
• It is generally believed that longer implants (length >13 mm) have higher success rates
than standard implants (length = 13mm)
• A total of 244 standard and 536 long implants were inserted and immediately loaded. The
mean follow-up was 3 years.
• Only 4 of 780 implants (99.5%) were lost, and these 4 were all 13 mm long.
• Only 4 of the 244 13-mm-long implants were lost (98%), but this was statistically different
from the survival rate of longer implants.
• Poor quality bone was related to increased marginal bone loss and thus a worse outcome in
both groups.
• IL standard length implants have a high survival rate, but it is statistically worse than that of
IL longer implants. Standard or longer implants are reliable devices for insertion in poor
quality bone, although slightly higher bone resorption is to be expected.
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M. Degidi & A. Piattelli International Journal Of Oral And Maxillofacial Surgery 2014

24. 3. IMPLANT BODY DESIGN:
• Threaded implants are preferred in comparison to
press fit implants.
• The increase in the number and depth of threads, corresponds
to the increase in the functional surface area of the implants,
hence corresponds to better load distribution, which is critical
in the success of immediate loading of implants.
• The thread depth of the implant body is related to the initial
functional surface area for immediate load.
• Implant design affects functional surface area more than
implant size – Square thread design are better than v shaped
thread design.
• Parallel walled threaded are better for immediate loading
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25. IMPLANT SURFACE CONDITIONS
• Implant surface conditions affect the rate of bone contact , lamellar bone
formation and percentage of bone contact which are beneficial in immediate
loading.
• HA coatings decrease the remodeling rate , therefore beneficial in D4 bone and
may decrease the risk in case of immediate loading.
• Calcium phosphate coated and titanium plasma sprayed also have been found to
increase BIC.
• Coating or surface condition is most beneficial during initial healing and early
loading conditions.
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26.  The greater the occlusal force applied to the prosthesis , the greater the stress at the implant
bone interface and the greater the strain to the bone.
 Patients with parafunctional habits present with increased duration and magnitude of force
along with a more horizontal direction of force on the implant with a greater shear
component.
 Parafunctional loads increase the risk of abutment screw loosening, un-retained prosthesis or
fracture of the transitional prosthesis used for immediate loading.
 One should have narrow occlusal tables and eliminate posterior cantilevers for immediately
loaded implants.
 Axial load to the implant bodies are preferred whenever possible.
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PATIENT FACTORS

27. IMPLANT POSITIONS
• Splinted arch position concept is advantageous in
immediate loading as it is effective in reducing
stresses to the entire implant support system.
• In the completely edentulous maxilla:
• Anterior implants - bilateral canine position and
• Posterior implants -first- to second-molar
position for the largest anteroposterior (A-P)
dimension.
• When forces are greater, the dentist should
insert an additional implant between the canines.
• In the mandible:
• At least three implants, one in the anterior and
one in each posterior region, are necessary.
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• The modulus of elasticity of bone is related to the bone quality. The less dense the bone, the
lower the modulus.
• The strength of the bone is also directly related to the density of the bone.
• The amount of bone–implant contact is also decreased for less dense bone.
• Cortical bone is more likely to remain lamellar in structure during the immediate loading
process, compared with trabecular bone.
• More implants, larger implants (length and width), greater surface area, implant designs,
implant positions with greater A-P dimensions, and reduced cantilevers should all be
considered in lower density bone types.
MECHANICAL PROPERTIES OF BONE

29. DIAGNOSIS AND TREATMENT PLANNING
• Reason for extraction of tooth.
• General systemic and oral health status
• Amount of available bone , bone shape,
quality, width and height
• Sufficient distance from maxillary sinus
floor, inferior alveolar canal
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A minimum of 4-5mm of bone width at
the alveolar crest and 10mm length
above inferior alveolar canal
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30. TOOTH EXTRACTION AND IMPLANT PLACEMENT PROCEDURES
• Teeth to be removed and implants placed immediately after
extraction can be assessed using either an open flap surgery or a
minimally invasive surgical technique.
• Avoid damaging the buccal plate during extraction.
• Surgical guides should be used for precise osteotomy site
preparation.
• In anterior region, the implants must correspond to the incisal
edges of the adjacent teeth or be slightly palatal to this landmark.
• Implant should be placed at least 3mm apical to the imaginary line
joining the cementoenamel junction of adjacent teeth- Good
emergence profile
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31. IMMEDIATE LOADING PROTOCOLS
 Patients should be healthy or a controlled systemic condition
 Cigarette smoking to be avoided
 Avoiding /reducing bone tapping of the osteotomy site or tapping osteotomies
sites in dense bone only.
 Engaging both cortices where available to provide bicortical stabilization
 Performing under preparation of the osteotomy site using narrower twist drills
 Using wider implant when primary stability was not obtained with the initial
implant.
 Avoid placing immediate loading in areas of active infection.
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32. PRIMARY STABILITY
• Primary stability is one of the most critical
factors and must be obtained at the time of the
implant’s insertion, before any load is applied.
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33. PERIOTEST
• An electronic device, the Periotest (Siemens AG, Bensheim,Germany),
• able to measure the damping characteristics of the periodontium in a very reproducible
way,
• permit the objective discrimination between an implant that has a close bone apposition
and one that is fibrously encapsulated.
• of values ranging from -8 to -50
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34. Resonance frequency
analysis
• Developed by Meredith and colleagues, provides a clinical,
noninvasive, and nondestructive method to assess the implant
stability and osseointegration
• Resonance Frequency Analysis (RFA) is the measurement of
the frequency with which a device vibrates.
• A Smart Peg sensor is mounted on top of the implant and the
sensor is then brought to vibration by gently moving it with
magnetic pulses. The sensor will vibrate for a short while and
then stop.
• If the implant stability (stiffness of the bone-implant interface)
increases, the vibration frequency of the sensor will increase.
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RESONANCE FREQUENCY
ANALYSIS (RFA)

35. The role of primary stability for successful immediate loading of dental
implants. A literature review. Journal of dentistry.
• Objectives: To assess the role of primary stability for successful immediate loading
(IL) of dental implants.
• Original articles studying the role of primary stability for successful immediate
loading of dental implants were included.
• Results:
• There is a significant biological response by the hard and soft tissues to IL of dental
implants.
• Within the limitations of the present literature review, it is evident that the core
issue to observe during IL is the establishment of a good implant primary stability.
• There is sufficient evidence to suggest that the degree of achieved primary stability
during IL protocols is dependent on several factors including bone density and
quality, implant shape, design and surface characteristics and surgical technique.
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Javed F, Romanos GE. The role of primary stability for successful immediate loading of dental implants. A literature review.
Journal of dentistry. 2010 Aug 1;38(8):612-20.

36. COMPLETELY EDENTULOUS PATIENTS
• Option 1: Loading the implants the same day as the surgery.
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De Bruyn H, Raes S, Östman PO, Cosyn J. Immediate loading in partially and completely edentulous jaws: a review
of the literature with clinical guidelines. Periodontology 2000. 2014 Oct 1;66(1):153-87.

40. Option 2 : Split the surgical appointment from the prosthesis delivery
appointment
• Place the implants and make an impression at surgery.
• In addition, the dentist records a vertical occlusal
dimension and centric bite registration.
• The bite registration may be made with the shell of the
transitional restoration on the abutment or with a
baseplate and wax rim (made before surgery and relined
as necessary).
• The laboratory pours the impression and selects and
prepares the abutments for the restoration and
fabricates a transitional prosthesis.
• Then at the suture removal appointment 7 to 12 days
later, the dentist delivers the transitional fixed prosthesis.
• After healing 4 to 8 months (dependent on the bone
density) the transitional restoration may be cut off and
the final prosthesis fabricated
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41. DIET:
• If immediately loaded prosthesis becomes
partially un-cemented or fractures, the
remaining implants are at increased risk of
overload failure.
• Diet of the patient should be restricted
only to soft foods in order to avoid
overloading the provisional prosthesis.
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42. All on 4 and all on six concept
• First described by Paulo Malo, Lisbon, Portugal in his
state of art all-on-4tm concept.
• The back implants are slanted distally to place the
implant head at the second premolar or first molar
position.
• Longer implants, stabilizing them into the anterior
higher density bone, and reduces the distal cantilever
of the prosthesis.
• 10 to 12 unit screw retained metal to plastic (hybrid)
splinted prosthesis is placed over these implants.
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All four implants in position, two distally tilted
back implants and two straight anterior
implants
A 30° multiunit abutment is being screwed on the
top of distal implant to correct the prosthetic
angulations

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The long flanges and palatal extension
of the denture are removed
Healing abutments are replaced
with the titanium cylinders
Prefabricated denture or patient’s
old denture is used to make the
immediate fixed provisional
prosthesis.

45. IMMEDIATE LOADING OF IMPLANTS
WITH OVERDENTURE PROSTHESIS
• In early progressive loading, the dentures are not
worn for 1 to 2 weeks, or else worn, but completely
relieved from the healing abutment.
• relined after 3 to 4 months when the definitive
prosthesis and attachments (ball or bar assembly) are
connected.
• In immediate early functional loading, the retentive
attachments are connected within 5 days ( bar/clip).
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50. Comparison of patient-reported outcomes between immediately and conventionally
loaded mandibular two-implant overdentures: A preliminary study
Yuri Omura Journal of prosthetic dentistry 2016
• To compare patient-reported outcomes between immediately and
conventionally loaded mandibular two-implant overdentures retained by
magnetic attachments
• 50 participants. Each participant received 2 implants in the inter-foraminal
region by means of flapless surgery. Prostheses in the immediate and
conventional groups were loaded using magnetic attachments on the same day
as implant placement or 3 months after surgery, respectively.
• Immediate loading of mandibular two-implant overdentures with magnetic
attachments tends to improve oral health-related quality of life and patient
assessment earlier than observed with a conventional loading protocol.
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51. The Partially Edentulous Patients
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Nonfunctional Immediate Teeth Concept
The N-FIT concept presents a similar approach to the immediate-
loading technique for the completely edentulous patient, with two
major exceptions.
1st : Rather than submerge more than half the implants or place extra
implants in case of failure, most often the ideal number of implants
is positioned in the ideal locations for the final prosthesis.
2nd : The implant-supported transitional prosthesis is placed out of all
direct opposing occlusal contacts during the bone-healing period.
Because the patient most often has enough remaining teeth in
contact to function, the transitional restoration is primarily for
esthetics, and the implant prosthesis is completely out of
occlusion.

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• Indications
• • Partially edentulous patients with centric occlusal contacts and excursions on natural
teeth (or healed implants)
• • D1, D2, and D3 bone in regions of implants
• • Screw-shaped implant bodies, 4 mm or more in diameter, with increased surface area
designs to decrease crestal stresses (e.g., BioHorizons Maestro dental implant)
• Contraindication
• • Patients with parafunctional oral habits (i.e., anterior and lateral tongue thrust or biting on
a pipe while smoking)

53. • Advantages of Nonfunctional Immediate Teeth
• Patient has a fixed esthetic tooth replacement soon after stage I surgery.
• No stage II surgery is necessary (eliminates discomfort for the patient and decreases
overhead for the doctor).
• Implants are splinted during initial healing for biomechanical advantage.
• The greatest bite force is only during eating and is less than 30 psi. No parafunctional forces
from occlusion are possible.
• Countersinking the implant below the crestal bone is eliminated, which reduces early crestal
bone loss.
• The soft tissue emergence may be developed with the transitional prosthesis and the tissue
allowed to mature during the bone-healing process.
• The soft tissue is mature when the final restoration is fabricated because the tissue has
been healing for many months. If surgical correction is required, then the dentist still may
perform the correction before the final bone maturation.
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54. • Disadvantages of Nonfunctional Immediate Teeth
• Micromovement of implant that can cause crestal bone loss or implant failure is greater
than with two-stage approach.
• The dentist is less likely to reflect the tissue at stage II and can evaluate implant crestal bone
directly.
• Parafunction from tongue or foreign habits (pen biting) may cause trauma and crestal bone
loss or implant failure.
• Impression material or acrylic may become trapped under tissue or between the implant
and crestal bone. This problem is reduced greatly if the crest module of the implant is larger
in diameter than the implant body.
• Bone that is too soft, small implant diameters, or implant designs with less surface area may
cause too great crestal stress contours and cause bone loss or implant failure
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55. TWO CLINICAL APPROACHES TO THE N-FIT TECHNIQUE
• The first option is to use a surgical-prosthetic protocol similar to immediate loading with a
diagnostic waxup to fabricate the provisional restoration. Once the implants are inserted,
the dentist recontours and relines the acrylic provisional prosthesis to the abutments
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58. Second alternative
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60. SINGLE-TOOTH NONFUCTIONAL IMMEDIATE-RESTORATION
PROCEDURES
• Worhle and Misch presented the single-tooth immediate restoration in 1998
• The single-tooth implant is considered for immediate restoration most often when the
following occur:
• 1. The natural tooth requires extraction and is still present in the mouth.
• 2. The natural tooth is in the esthetic zone.
• 3. The soft tissue drape in its current form is ideal.
• 4. The bony housing around the natural tooth is intact, including the facial plate.
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61. Transitional Restoration
• Two options exist for the transitional
restoration for a single-tooth immediate
implant restoration:
• 1st: An acrylic crown with no occlusal
load for 3 to 4 months. In addition, the
transitional crown may be splinted to a
natural tooth that has no clinical
mobility (i.e., a canine).
• 2nd: A premade crown is modified to fit
over the abutment and places the
gingival margin in close approximation
to the tissue.
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64. RISKS OF IMMEDIATE OCCLUSAL
LOADING
• Early crestal bone loss after implant loading may have a relationship to occlusal
overload.
• The early loading was speculated to interfere with the ability of necrotic bone
(created by the surgical trauma) to be replaced by newly formed bone.
• Successful implants with greater than 5-mm soft tissue pockets may be more
often a result of immediate loading.
• In the immediate-loading technique for the completely edentulous patient, more
implants usually are inserted, which increases the fee and makes patient
acceptance less likely.
• Implant failure may increase a malpractice case against the dentist, especially
because the patient may need to wear a removable prosthesis and may be
subjected to several additional surgeries and appointments.
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65. REVIEW OF LITERATURE
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66. Immediate Loading of Single Implants in the Anterior Maxilla: A 1-Year
Prospective Clinical Study on 34 Patients
• Aim : To present the outcomes of immediately loaded single implants placed in the
anterior maxilla.
• Methods:
• 34 patients
• 43 tapered implants
• Inclusion criteria were single-tooth placement in postextraction sockets or healed sites
of the anterior maxilla.
• All implants were immediately loaded and followed for a period of 1 year after the
placement of definitive crowns.
• Results: Positive outcomes were reported, with high survival (100%) and success
(95.2%) rates
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67. Immediate versus delayed functional loading of implant in the posterior
mandible: a 2-year prospective clinical study of 12 consecutive cases
• Aim : To evaluate the clinical success of
immediately loaded implants versus
implants loaded in a delayed fashion in
the posterior mandible. Three implants
were placed distal to the canines
bilaterally in the edentulous distal
mandibular ridges of 12 patients.
• Results: Twenty-nine of the examined
sites showed no bone loss. After 2
years of loading in the posterior
mandible, test and control implants
had the same prognosis
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Romanos GE, Nentwig G. Immediate versus delayed functional loading of implant in the posterior mandible: a 2-year prospective
clinical study of 12 consecutive cases. Int J Periodontics Restorative Dent. 2006;26:459–469

68. Changes In Alveolar Bone Density Around Immediate Functionally And
Non-functionally Loaded Implants
• Aim: T o quantitatively assess radiographic changes in alveolar bone density around
immediate functionally and nonfunctionally loaded implants.
• Material and methods. A prospective longitudinal study was conducted in which 20
participants with partially edentulous mandibles received implants that were immediately
loaded either functionally (IFL) or nonfunctionally (INFL). Standardized intraoral periapical
radiographs were made at baseline, 3, and 6 months.
• Results: Immediate loading of implants helps to stimulate bone ossification around implants
at the lateral apical level and at the crest from 3 months to 6 months.
• Furthermore, the immediate functional loading of implants resulted in a significantly greater
degree of bone demineralization at the alveolar crest from the time of implant placement up
to 3 months compared with immediate nonfunctional loading.
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Ramachandran A, Singh K, Rao J, Mishra N, Jurel S, Agrawal K The Journal Of Prosthetic Dentistry. 2016;115(6):712-717.

69. Immediate loading of implants placed in patients with untreated periodontal
disease: a 5-year prospective cohort study.
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Maló P, de Araújo Nobre M, Lopes A, Ferro A, Gravito I. Immediate loading of implants placed in patients with untreated periodontal
disease: a 5-year prospective cohort study. European journal of oral implantology. 2014 Sep 1;7(3).
Purpose: To report the 5-year outcome of immediately
loaded dental implants in patients with untreated
periodontal disease.
Method: 103 consecutive patients were rehabilitated
with 380 implants supporting 145 prostheses in both
jaws .
The implants were inserted in patients with active and
untreated periodontitis. The patients did not receive any
previous periodontal treatment before implant surgery,
except for an oral hygiene session immediately before
the implant surgery. In maintenance (every 6 months)
patients received periodontal treatment as needed.

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Conclusion: A cumulative survival rate of 97.9% and 99.4% at 5 years of follow up was noted.
Rehabilitation of patients with untreated periodontitis using immediately loaded dental
implants is feasible, when periodontal therapy is provided after rehabilitation and the
patients are regularly maintained.

71. • Objective: To assess longitudinal quantitative changes in bone
density around different implant loading protocols and implant
surfaces measured by digital subtraction radiography (DSR).
• Methods: 12 patients received bilateral homologous machined
surface standard implant and an oxidized surface implant TiUniteH
(Nobel Biocare, Kloten, Switzerland) single-tooth implants under 2
implant—loading protocols: immediate loading and conventional
loading.Standardized periapical radiographs were taken immediately
after implant placement (baseline image) and at the 3-month, 6-month
and 12-month follow ups. Radiographic images were digitized and
submitted to digital subtraction using the DSR system.
• Results: No effect of implant surface treatment was observed.
• IML protocol induced mineral bone gain around single-tooth implants
after the first year under function for cases with favourable bone
conditions.
Carneiro L, da Cunha H, Leles C, Mendonça E Dentomaxillofacial
Radiology. 2012;41(3):241-247.
Digital subtraction radiography evaluation of longitudinal bone
density changes around immediate loading implants: a pilot study
19 72

72. Survival rates and bone loss after immediate loading of implants in fresh
extraction sockets (single gaps). A clinical prospective study with 4 year
follow-up.
• Aim: of this prospective study was to report the outcome of treatment with implants
inserted after tooth extraction and immediately loaded.
• Fifty-six patients with single tooth loss were treated with 116 IPX Galimplant® implants with
internal connections and a sandblasted, acid-etched surface. All implants were placed after
tooth extraction using a flapless approach without bone regeneration, and they were then
immediately loaded with cemented acrylic prostheses. After a period of three months,
definitive cemented ceramic prostheses were placed.
• Clinical results indicate an implant survival and success rate of 97.4%. dental implants that
are inserted after tooth extraction and immediately loaded may constitute a successful and
predictable alternative implant treatment.
01-05-2018 70 73
Velasco-Ortega E, Wojtovicz E, España-Lopez A, Jimenez-Guerra A, Monsalve-Guil L, Ortiz-Garcia I, Serrera-Figallo MA. Survival rates and
bone loss after immediate loading of implants in fresh extraction sockets (single gaps). A clinical prospective study with 4 year follow-up.
Medicina oral, patologia oral y cirugia bucal. 2018 Feb.

73. Immediate Loading of Short Implants in Posterior Maxillae: Case Series
• Aim: To evaluate immediate loading of short dental implants in the posterior regions of the
maxillae.
• Materials and methods
• Patients having short implants ( 7.5 mm or 8.5 mm) in maxillae posterior areas inserted
before December, 2010 and immediately loaded were selected
• Result: One prosthetic complication occurred. No prostheses failed resulting in a survival
rate of 100%.
• The immediate loading of short implants in maxillae posterior areas could save time, cost
and could be regarded as a successful treatment.
01-05-2018 70 74
Anitua E. Immediate Loading of Short Implants in Posterior Maxillae: Case Series. Acta stomatologica Croatica. 2017 Jun
20;51(2):157-62.

74. Conclusion
01-05-2018 7570
Patient care requires implants to restore function, esthetics, bone and soft
tissue contours, speech and intra oral health.
In some patient conditions, the delayed healing process can cause
psychological, social, speech and or function problems.
Immediate restoration of a patient after implant surgery is one of these
alternatives.
Careful patient screening and selection are required when an immediate
implant placement with immediate loading procedure is a treatment
consideration.

75. References and Cross-References
• Contemporary implant dentistry 3rd edition Carl E. Misch
• Endosteal Dental Implants: Mc kinskey
• Osseointegration and dental implants: Jokstad
• Implant dentistry today: A multidisplinary approach 3rd edition Piccin
• Principles and Practice of implant dentistry: Weiss
• Oral rehabilitation and Implant supported prosthesis: Jimenez- Lopez
• Computer-guided versus free-hand placement of immediately loaded dental
implants: 1-year post-loading results of a multicentre randomised controlled
trial : Pozzi et al Eur J Oral Implantol 2014;7(3):229–242
• Immediate loading of implants placed in patients with untreated periodontal
disease: A 5-year prospective cohort study
• Factors Affecting the Outcome in the Immediate Loading Rehabilitation of the
Maxilla: A 6-year Prospective Study : Paulo Pera et al Int J Periodontics
Restorative Dent 2014;34:657–665. doi: 10.11607/prd.1970
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76. References and Cross-References
• Immediate non-functional versus immediate functional loading and dental
implant failure rates: A systematic review and meta-analysis: RC BRUNO:
journal of dentistry 42 (2014)1052 – 1059.
• Immediate Versus Early Loading of Mini-Implants Supporting Mandibular
Overdentures: A Preliminary 3-Year Clinical Outcome Report :HM Waleed et
al Int J Prosthodont 2014;27:553-560.
• Distal Cantilever in Full-Arch Prostheses and Immediate Loading: A
Retrospective Clinical Study : ER Giorgious : Int J Oral MaxiIllofac implants
2014;29:427-431
• Evaluation of crestal bone loss and stability of immediate functional loading
versus immediate non-functional loading of single-mandibular posterior
implants: A pilot randomized controlled clinical trial : Mantena et al. Dental
Research Journal September 2014 Vol 11 Issue 5
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