The placement of implants that can integrate with bone to replace natural teeth lost due to decay, trauma, or congenital absence has been one of the most significant advancements in restorative dentistry. The original protocol proposed in 1952 by Per-Ingvar Brånemark, the pioneer of dental implants, recommended a healing period of 3–6 months before restoring and loading dental implants. This waiting period allowed soft and hard tissues to heal properly and ensured osseointegration (bone integration).
However, patients’ immediate functional and aesthetic demands have led to the development of faster and more efficient implant techniques.
With advancements in implant surface technology and design, it has become possible to place implants directly into extraction sockets and load them immediately with a prosthetic restoration. Immediate loading reduces the number of surgical procedures and enables patients to regain function and aesthetics in a much shorter time.
Nevertheless, certain conditions and limitations must be considered. Factors such as the quality and quantity of existing bone, the anatomical position of the implant, the presence of systemic diseases, the use of specific medications, and parafunctional habits play a critical role in determining treatment success.
The placement of implants into fresh extraction sockets and determining the optimal loading protocol remain subjects of debate. Studies indicate that in patients with previously extracted and healed bone sockets, no specific loading protocol appears superior in terms of implant and/or prosthetic failure or marginal bone loss around the implant neck.
However, one of the most critical factors is achieving adequate primary stability within the bone socket. If sufficient primary stability cannot be obtained, immediately loaded implants may have a higher failure rate.
Recent studies demonstrate that the immediate loading protocol offers many advantages for both the patient and the clinician. It helps preserve soft tissue height after extraction and may improve peri-implant bone density. Furthermore, immediate loading has been associated with reduced postoperative pain, shorter chair time, and decreased use of dental materials, with reported success rates ranging between 95% and 100%.
Advantages of Immediate Loading Implants
Continuation of Social Life
One of the greatest advantages of immediate loading implant treatment is the significant reduction in overall treatment time. With traditional implant protocols, patients may need to wait several months before receiving their definitive prostheses.
In contrast, with the immediate loading protocol, a temporary prosthesis can often be completed within two sessions. This allows patients, especially those with busy work schedules, to quickly regain their smile and continue their social and professional lives without interruption.
Patient Comfort
Immediate loading implants provide a more comfortable postoperative experience. Since screw-retained temporary plastic prostheses can be attached immediately after implant placement, patients do not have to remain edentulous for an extended period.
This enhances overall patient satisfaction and minimizes treatment-related inconveniences.
Preservation of Bone and Gingival Tissue
Immediate loading can help preserve existing bone and soft tissue structures and prevent physiological bone resorption that may occur while waiting.
When a tooth is lost, the surrounding bone and gingival tissues may gradually resorb over time, leading to tissue loss. By placing the implant immediately after extraction, the implant functions as a space maintainer, supporting the natural contours of the jawbone and gingiva.
As a result, further bone loss can be minimized, gingival contours can be preserved, and patients can achieve more aesthetic outcomes.
Disadvantages of Immediate Loading Implants
Not all patients who experience tooth loss are suitable candidates for the immediate loading protocol. This is an essential consideration.
Factors such as bone quantity and quality, oral hygiene habits, general health status, and smoking can significantly influence treatment success.
In some cases, applying immediate placement and loading protocols in extraction sockets may require additional procedures such as bone grafting or other surgical interventions to properly support the implant. This may increase the overall treatment cost.
Patients treated with the immediate loading protocol must maintain strict oral hygiene to prevent infection and ensure proper tissue healing. This includes regular brushing, flossing, and the use of oral irrigators, as well as avoiding hard and sticky foods that may place excessive force on the implant.
Additionally, depending on jawbone structure and treatment planning, implants suitable for immediate loading may be more expensive than conventional implants. Although the number of implants required may not differ significantly from traditional approaches, factors such as the need for an experienced team and more complex planning can affect the total cost.
However, the shorter treatment duration and reduced number of appointments may help offset the increased expense.
Conclusion
Clinical success with the immediate loading protocol depends primarily on careful case selection and an experienced clinical team. Immediate placement and immediate loading are not suitable for every patient.
The oral surgeon and prosthodontist should collaboratively evaluate each case to determine whether the immediate placement and immediate loading protocol is appropriate.
