Introduction to Immediate Loading in Implantology

Abstract

Branemark traditional recommendation was to perform implant rehabilitation in two stages: the first entry was only for implant placement; after 3–6 months of undisturbed submerged healing for mandible and maxilla, respectively, a second surgical entry would have allowed loading of the implants. The rationale behind this approach was that implant micro-movements as consequence by an inadequate primary stability, caused by functional forces at the bone-implant interface in the early wound healing stages, could have induced fibrous tissue formation rather than new bone, eventually causing clinical failure. The main request was to reduce the overall rehabilitation time from surgery to final restoration delivery: installation of implants in fresh extraction sockets and immediate restored implants has been adopted. First reports on immediate loading of dental implants can be traced back to the early 1960s thanks to the contribution of Dr. Leonard Linkow. He described immediate loading protocols for root-form and blade implants. In 1979, Philippe D. Ledermann advised the placement of four non-submerged intra-foramina mandibular implants, in areas where the bone was at least 11 mm in height, and suggested to immediately load them with a splinting bar-retained restoration. Immediate loading implies that implants would be exposed to the oral environment and subjected to functional loads; therefore some biologic assumptions should be considered: Osseointegration would not be affected because of oral exposure of the implant surface. Osseointegration would not be affected because immediate loading and ideal healing time would be very sacrificed. Immediate loading protocol allows patients to wear their implant-supported prostheses before the first week after implant surgery, avoiding a secondary surgery.