IMMEDIATE LOADING OF DENTAL IMPLANTS: BRIEF PRESENTATION

12/9/2019

If you are looking for information about immediate loading implants, you will surely have found loads of conflicting information on the internet, in newspapers or at the dental practices you've been visited.
This article will try to clarify the fundamental aspects of this issue.
We want to focus in particular on those patients who need to rehabilitate an entire arch (place all the teeth above or all the teeth below).

Let's start with some simple concepts:
·      A dental implant is a screw made of pure titanium that is tighten into the bone under the gum. On this screw, new fixed teeth are anchored.
·      If one tooth is missing, a single screw is placed, if more teeth are missing, more screws are placed.
·      If all the teeth of an arch are missing, all can be anchored on four implants (in some cases six, but it is very rare)
·      If the screw stabilizes well into the bone, the fixed tooth or teeth can be placed immediately. These are immediate loading implants (imagine putting a screw in the cement or plywood, in the first case you can tighten it with the force you want, in the second case at some point the screw starts to turn in circles because the plywood becomes stripped). Therefore, if your bone is nice and hard (and this happens almost all the time), your fixed teeth can be placed straight away, but if it is a bit softer you will have to wait two months.
 
·      "Loading the implants" means attaching the fixed teeth.
Many patients who need to rehabilitate an entire arch are wondering: "But why only 4 implants and not 12? Do I need 12 teeth? If I choose more implants they will definitely last longer."
The reasons are two, one biological and one economic:

1. The biological aspect

Let's try to explain it with a simple metaphor: implants are like plants. If you put too many plants in a tight space, they will have trouble making roots, will lack in nutrients and will hardly grow. Some of them will die and the entire crop will be somehow compromised.
Four implants are the perfect number for a whole arch. Increasing this number involves, similarly to plants, more disadvantages than benefits.

2. The economic aspect

Since scientific research has shown that four implants are enough (some innovators are trying to make it work even with two), why would a patient pay six, eight or even twelve implants?
 
Another very frequent question among patients is "But why do we have to place the fixed teeth right away? Why not wait a bit, this way we are sure everything is okay?"
There are three reasons:
·         Scientific research has shown that immediately loaded implants (when they are stable enough) work just fine, as those loaded after two or four months.
·         Another indisputable advantage of immediately loaded implants is that the patient does not have to spend from two to four months with a denture that does not even allow them to eat because of the healing implants in the lower arch.
·         The second intervention to re-open the gums and connect the implants to the fixed bridge is avoided.
For the above reasons, to rehabilitate an entire arch where the teeth are useless or are not present at all, in our opinion, immediate loading of implants is the best solution, both biologically and economically.
One-hour intervention and about 24 hours to physically build the prosthesis, that's all it takes for you to have your brand new temporary fixed teeth.
Attention: the final bridge, the one with the best materials and intended to last in time, will be placed in three months after the intervention. 
 
We will conclude by presenting the two rare cases where immediate loading implants are not possible, and our solutions to overcome this problem.
 

1. Enough bone, but too soft

In this case, implants are placed, there is a waiting period of two months (in which unfortunately the patient will have to live with a temporary denture) and then fixed teeth are placed.
 

2. Not enough bone

It is the most uncomfortable solution for the patient, because it implies significantly longer times for solving their problem (from eight months to a year), as before placing the teeth, the bone has to be reconstructed. The final result is the same and patients are delighted with the work done, despite the greater effort they are required to make in terms of treatment duration.
 
  We will conclude with a final piece of advice based on our experience: if you are told that immediate loading implants are not possible in your case or even that it is impossible to place implants due to the lacking bone, before abandoning the idea of ​​improving your life, you might want to hear other opinions of more experienced implantologists.