Immediate implant loading

versus delayed loading

Presented by:
Gomaa soliman
Sherif mansour
Mohamed khataby
 Surgical protocols for dental
implant
According to no of surgeries
1-One Stage Implant
One Surgical Procedure

2-Two Stage Implant

Two surgical Procedure
 According to Time of Placement
1-Immediate implantation
The implant is placed at the time of extraction on a prepared socket
2-Immediate delayed implantation
Implant is placed 6 weeks after extraction after soft tissue healing

3-Delayed implantation
Implant is placed 6 months after extraction to allow bone healing
complete healing
 Immediate loading versus
delayed loading
Implant loading :
Refers to the prosthetic procedure of placing a
superstructure onto the implant fixture.

The classification depends on the time elapsed

between the time of fixture surgical placement into
the patients bone, and the time the fixture starts to
receive a superstructure, whether it was a
temporary or permanent superstructure
ssification according to timing of loading
Immediate Early loading Delayed loading
loading Early functional
loading
the the provisional
provisional the pro-
definitive
definitive visional
prosthetic
prosthetic definitive
construction construction is
prosthetic
is attached to attached at a
construction is
the implant second
attached to the
within 48 procedure after
hours of the implant within
a conventional
implant being daysweeks of
healing period
placed the implant
Davarpanah, M. &being
of 36 months
placed
Szmukler-Moncler, S., 2009. Immediate
Loading of Dental Implants Theory and Clinical Practice
sification according to prosthetic loading of implant

Occlusal loading Non-occlusal loading:

the crown the crown bridge

bridge is in is Not In contact in
contact with the centric occlusion
opposing with the opposing
dentition in dentition in the
centric natural jaw
occlusion position
Davarpanah, M. & Szmukler-Moncler, S., 2009. Immediate
Loading of Dental Implants Theory and Clinical Practice
 Classification according to
Early loading carl misch loading
Delayed
Early loading refers to It refers to implant
an implant supported prosthesis with an occlusal
restoration that is in load after more than 3
occlusion between 2 months after implant
weeks and 3 months placement.
after implant The delayed occlusal
placement. loading approach may use
A fundamental goal either a two-stage surgical
of early loading is procedure that covers the
improving bone implants with soft tissue or
formation in order to a one-stage approach that
support occlusal exposes a portion of the
loading at two months implant at the initial
surgery
Misch CE , Wang HL , Misch CM , et al : Rationale for the
application of immediate load in implant dentistry:
 The biomechanical definition of
:immediate loading is also debated

For some researchers, the concept of

immediate loading is satisfied as soon as the
coronal portion of the prosthesis is inserted,
even if it is kept out of occlusion.

For others, the term immediate loading can

be applied only if the prosthesis is subjected
to occlusal forces as soon as it is inserted.

Davarpanah, M. & Szmukler-Moncler, S., 2009. Immediate

Loading of Dental Implants Theory and Clinical Practice
 loading Immediate loading Delayed loading

Indication Adequate bone support for Poor bone quality for

implant primary stability
s Stabilization

In posterior maxilla with

Intact soft tissue
morphology for large marrow spaces and
aesthetics. thin cortex
 loading Immediate loading Delayed loading

Indication In patients with high loading

Partially edentulous forces as in cases of deep
s
patients with centric bites and malocclusion
occlusion contacts and
excursions on natural teeth
( or healed implants).

Screw shaped implant

bodies, 4 mm or more in
diameter with increased In cases of multiple implant
surface area designs to with
decrease crestal stresses. reconstructive surgery in
esthetic areas
Sufficient bone height
(i.e, approximately
12mm) for a minimum
length 10mm implant.
 loading Immediate loading Delayed loading

Indication In cases of bone grafting

and membrane placement
s

To prevent macro and micro

movements
 loading Immediate loading Delayed loading

contraIndi Insufficient bone Highly esthetic area with

concerning patient needs
cations volume.

Unable to achieve
primary stability.

Bruxism.

Poor oral hygiene.

No absolute
Signs of chronic contraindications
bone disease
 loading Immediate loading Delayed loading

Advantag Enhanced bone healing and

greater predictability for osseointergration without
es treatments with immediate bacterial colonization and
loading with a success rate inflammation
of 96.1% after 40 months

greater satisfaction indices

from patients because only
one operation was
necessary

Countersinking the implant

below the crestal bone is
eliminated, which reduces Minimizing micromovement
early crestal bone loss of implant without fibrous
encapsulation

The patient does not need

to wear a removable
prosthesis during healing
time.
 loading Immediate loading
Advantag
es The implant abutments are
placed at the time of
surgery or at the suture
removal appointment.
A second stage surgery is
eliminated, along with a
suture removal
appointment.
This saves the patient pain
and suffering and saves the
dentist overhead time and
materials.
When immediately loaded,
the implants are splinted
together during healing
which is biomechanically
Delayed loading
Gave a chance for
the clinician to
evaluate the degree
of osteointegration
before loading as in
cases of:
Questionable
primary satbility.
Patient with impaired
healing
response(systemic
disease, diabetes,
Previous history of
radiation therapy
etc).
 loading Immediate loading Delayed loading

Dis Micromovement of implant Second surgical procedure

dvantages that can cause crestal
bone loss or implant failure
is greater than with two-
stage approach.

Implant overload failure

occurs, several side effects
follow; Implant overload
microgap at the implant
failure most often is abutment interface
associated with bone loss
around the implant.

If the bone loss includes a

lateral cortical plate, then
the bone width will not
regenerate; bone graft is
required.
 loading Immediate loading Delayed loading

Dis Parafunction from tongue or more time more

dvantages foreign habits ( pen biting)
may cause trauma and visits and more costs
crestal bone loss or failure. are required.
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 implant is
larger in diameter than the The patient will have
implant body.
to be wearing a
removable
Bone that is too soft, small prosthesis, or an
implant diameter, or
implant design with less
interim prosthesis
surface area may cause too that might not meet
great crestal stress
Implant type for each loading protocols

Factors affecting selection of immediate and

delayed loading
1- increase the surface area
2-Decrease force conditions

Turkyilmaz, I. & Hoders, A.B., Immediate Loading in

Implant Dentistry.
 1-Increase the surface area
a) Implant numbers:
Functional surface area of occlusal load at implant
interface can be increased by increasing the implant
numbers

Turkyilmaz, I. & Hoders, A.B., Immediate Loading in

 B) Implant diameter and length:

Implant diameter and length are often emphasized

in reports as these values give insight into the
bone-to-implant surface area that an implant will
provide.
For each 3mm increase in length beyond 10mm,
you can increase the surface area by more than
20% for a cylinder implant design.

Turkyilmaz, I. & Hoders, A.B., Immediate Loading in

Implant Dentistry.
 B) Implant diameter and length:
Benefits of increased length are found in the initial
stability of the bone implant interface.
Added length can also allow implant to engage
opposing cortical plate which can increase initial
stability.
When trying to evaluate what length implant should
be placed, it is important to consider that the
survival rate of 10mm or less implants drops to less
than 85% in traditional healing

Turkyilmaz, I. & Hoders, A.B., Immediate Loading in Implant

 B) Implant diameter and length:
The functional surface area of each implant
support system is related to the width and shape
of the implant.
Wider root form implants of the same length
provide greater bone contact than narrower
implants.
Occlusal stresses are greatest in concentration at
the crest of the ridge after the implant has
integrated, so the width may be more important to
the length of the implant to decrease the risk of
crestal bone overload.

Turkyilmaz, I. & Hoders, A.B., Immediate Loading in

 C)Implant body design:
The implant design has a greater impact on the
functional surface area than the implant size
The functional surface area is greater during
immediate load, and a threaded implant presents
many advantages over a press fit type of implant
for immediate load because the design features do
not require integration to resist loads and have a
greater surface area to resist occlusal forces

Turkyilmaz, I. & Hoders, A.B., Immediate Loading in

 C)Implant body design:
The number, spacing, and orientation of the
threads affect the amount of area available to
resist the forces during immediate loading
Thread geometry can affect the strength of early
osseointegration and bone implant interface.
V- shaped thread design withstands a 10x greater
shear force applied to bone compared to a square
thread shape.

Turkyilmaz, I. & Hoders, A.B., Immediate Loading in

 C)Implant body design:
When considering a tapered implant design for
immediate load, consider that this type of design
allows for a less overall surface area compared to a
straight design of the same length, width, and
thread number.

Turkyilmaz, I. & Hoders, A.B., Immediate Loading in Implant

 D) Implant surface condition:
When the implant surface is modified with a
roughened texture, this increases the bone to
implant contact
The surface condition affects the rate and
percentage of bone contact, and lamellar bone
formation.
Surface coatings and conditions of the implant have
been shown to be most beneficial during the initial
healing and early loading conditions.

Turkyilmaz, I. & Hoders, A.B., Immediate Loading in

 Criteria for success

Munjal, S. & Munjal, S., 2011. Immediate Implant

Loading: Current Concepts