Loading Considerations for Implants

Abstract

SUMMARY Loading of implants is more complex than normally recognized. Certain guidelines for improving long-term implant service should be considered. 1. Select the implant best suited for a particular site. The proper diameter and length should be used to maximize cortical plate engagement. 2. Emphasize implant placement in the posterior region of the oral cavity. Chewing forces are far more diverse in the posterior and can be particularly traumatic for implants. 3. Understand that the overall geometry of an implant is far more biomechanically important than smaller surface configurations, such as threads, vents, or fins. The more rootshaped, the better. 4. Precision stents, which include locations for primary implants, locations for secondary implants, and alignment guides for all implants, are biomechanically essential. Proper group alignment of all implants is particularly important. 5. Avoid sleepers. They serve no biomechanically justifiable purpose. 6. Minimize healing periods to achieve os- teointegration but to avoid bone demineralization. If extended healing periods are necessary, gradually load the implants to allow the supporting bone to remineralize. 7. The placement of implants in fresh extraction sites has certain biomechanic advantages. Be aware, however, that the healing process is more variable and will require close monitoring. 8. Stress concentrations are going to occur that make implant component failure inevitable. Maximize all the advantages present to delay the failure.