Q: Immediate Loading. How? What is the best way to approach?
A: First of all, I do not recommend immediate loading until at least 1 week after surgery. This is due to movement. If the movement within 1 week is more than 20 microns, the implant has a high chance to fail. After 1 week of healing, up to 100 microns is allowed. This has to do with cell biology. In the first week, differentiation of stem cells occurs. The stem cells within bone marrow spaces can differentiate into two types of cells: fibroblasts and osteoblasts. If the movement of the implant is more than 20 microns, the stem cells will tend to differentiate into fibroblasts instead of osteoblasts. This is not good. When Immediate loading is needed, we must consider some things. First, bone, second, implant size, and third, number of implants. For bone, the denser the better. For D1 bone, immediate loading is quite possible and easy, as long as the inter-thread bone is preserved. This is the main point about bone. With IBS system, if the interthread bone is preserved and not damaged, immediate loading and early loading is possible when you have the required bone quality (D1, D2). Early loading here means 4 weeks. Bigger and longer diameter implants are obviously better for immediate loading. Also, it may be impossible to immediately load and have success with a single implant. If possible, do a bridge, with multiple implants to distribute the forces across them.
Also, there are two types of immediate loading. Functional and non-functional. The above is related to both types, but more important for functional. Non-functional mainly refers to aesthetic regions. For the anterior, there are 2 major factors. The patient’s tongue, and occlusal force. The tooth should have no touching to other teeth during occlusion. The tongue should not come into contact with the tooth either. Especially for the anterior teeth, the buccal surface should be smoothened, lest the patient will tend to rub that surface with the tongue resulting in failure. Make the surface smooth, or make an angulation so that the tongue cannot touch at all.
Xin Wei, DDS, PhD, MS 1st edition 05/25/2017, last revision 05/25/2017