What are the advantages of immediate loading implants?
Immediate loading is the placement of prostheses on implants immediately or a few days after insertion of the implants. This stimulation of the peri-implant bone with masticatory loads helps the bone to become denser and capable of supporting mastication.
Currently, we speak of immediate loading when implant-supported prostheses are made and the implant is functionally loaded in less than two days. On the other hand, in the non-functional immediate loading or immediate restoration, the prostheses are placed in the same time, but out of occlusion. We would also find conventional loading, in which we wait between 3-6 months to load the implants. Finally, we would find the early loading that is performed between two days and three months after implant placement.
The popularity of immediate loading has been growing because it shortens times and avoids temporariness. This modality is the result of improvements in design, application of appropriate biomechanical principles and refinement of clinical protocols.
Immediate implant loading allows osseointegration equal to that obtained with the traditional two-stage method. However, over time, certain principles of the traditional protocol have been modified in order to evolve to immediate loading.
What is primary implant stability and why is it important?
Many authors agree that immediately loaded implants must have a specific primary stability (absence of implant movement after insertion). For this purpose, a manual mobility test is performed using a light force of a metal object on the implant mount. In this way, the implant stability can be assessed in a non-invasive way. The results are measured in ISQ values (implant stability coefficient), which respond to a range of sound frequencies:
- ISQ less than 40: high failure rate.
- ISQ less than 49: implants with doubtful success.
- ISQ > 49: high success rate
- ISQ 60-65: implants suitable for immediate loading.
Then we would find the insertion torque of the implant. This is a non-invasive method that also allows determining the primary stability of the implant. Torque is the name given to a lever that rotates something else. The optimum level to achieve the primary stability of the implant is between 35-50 Nw.
As for the bone, we also find different typologies. Misch’s classification distinguishes different bone qualities:
- D1: Dense compact bone
- D2: Dense and porous compact bone with dense trabeculation
- D3: Thin porous compact bone with fine trabeculation
- D4: Cancellous bone with trabeculation
The first three types are the most suitable for conventional implantology, while according to Misch, the D4 types are the ones with the highest risk of implant loss.
What are the improvements compared to the traditional method?
The placement of these implants after extraction serves to prevent bone and tooth loss, helping to avoid having to restore the implant in the future. In addition, the immediate implantation reduces the treatment time.
The ideal conditions for the placement of immediate loading implants are rough surface and threaded implants.
What are the advantages of these implants?
- Less resorption of marginal bone ridge around implants
- Increased bone-implant contact in the short term
- Allows ideal implant position
- Extraction provides favorable vascularization for bone healing and regeneration
- Preserves bone and soft tissue patrimony.
- Reduces surgical times. Avoids 2nd surgery to expose implants
- Provisional resolution
- Shorter treatment time
- By not having to perforate the cortex we generate less heat when cutting with the rotary instruments even with refrigeration.