Nowadays evaluation criteria of implant treatments are extended to not only esthetic concern, but also the amount of time consuming. Esthetics shouldn’t be underestimated in each stage of treatment planning regarding to it’s possible psychological effects. For this reason, implant design and treatment planning approach are evolved for provide customer satisfaction in a little time- immediately if it is possible.

Immediate loading can be considered as a newer protocol includes prosthetic-load timing since Brånemark introduced the osseointegration system in 1977 [1]. Conventional methods suggest treatment planning should be depend on the natural osseointegration duration which takes 3-4 months in mandible and 6 to 8 months in the maxilla [1]. To by-passing this duration, new protocols are proposed to aim of shortening the treatment time.

Immediate loading, also known as “same-day loading” is a technic that incorporate a prosthetic superstructure that allows occlusal contact during the first one or two days of implant placement or in other words, it is a situation in which superstructure is attached to the implants within 72 hours of surgery [2]. In this limited time, the main requirement should be providing adequate initial stability. Initial stability is the most important which is affected by quantity and quality of bone, surgical technique, and implant design [3].

Surgical factors affect the bone quality directly in case of difficult or uncontrolled surgical parameters. Heat related factors can be arised as a result of uncontrolled drilling. It has been shown that a temperature over 47 °C degrees for one minute cause heat necrosis in the bone [4]. In addition to this, inadequate drill sharpness and design creates unintended heat [4].

Occlusal factors are needed to be checked for eliminating undesired micromovements. One of the reasons for reducing the success in immediate loading is unbalanced prosthetic units to implant units ratio [3]. This ratio should be at least 1.4 in upper jaw and 1.5 in lower jaw [3]. These values can be revised related to the opposite occlusion, implant diameter, bone quality, implant design and other pressure factors [3].

Implant characteristic is a useful tool for treatment planning as well. Threaded implants are much more advantageous for immediate loading because of their designed Surface area.  Number, distance, and direction of the threads are also effective on the size of area [3]. The initial stability is superior to cylindrical types which are known to compress the surgical area of the implant (especially its coronal area) during implant placement [3] For immediate loading length of implant is important especially in the low-quality bones [3]. In addition to this, implant surface coating will be an indicator for stability process. Surface modifications for roughening implant surface are applied in production stage to increase BIC [4].

Apart from treatment and product planning, patient related factors should not be underestimated for patient selection.  Health background has importance when it comes to immediate loading. For the patients who has metabolic or systematic diseases, diabetes, osteoporosis or rickets, history of radiotherapy and ongoing chemotherapy should be taken into consider before treatment planning [3]. In addition to this, personal behavior like tobacco usage affects the treatment process [2]. Besides, oral conditions are needed to be evaluated. Bone quantity and quality are the leading factors for both implant and prosthetic loading procedures. Necessary value for torque can be achieved regarding to bone density. For this, imaging techniques like computerized tomography preferred for evaluation of residual bone [1]. Treatment plan should be fit for bone characteristic of the patient.

Time efficiency and improved aesthetics can be considered as main advantages of immediate loading. From the patient’s aspect, more surgery means longer healing period and valuable costs. Aesthetics will be another focused point. Losing a tooth or even the think of it has dramatic pressure on patient’s life. The missing teeth equals not to smiling or even talking which are the core things to communicate of human beings.

To sum up, dentists and implantologists should consider the individual patient's needs and circumstances when deciding whether immediate loading is a suitable treatment option, ensuring optimal outcomes and patient satisfaction. Efficient surgical planning is the main door that the professional opens to patient for the joyful treatment journey.

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References:

[1] Tettamanti, Lucia, et al. "Immediate loading implants: review of the critical aspects." ORAL & implantology 10.2 (2017): 129.
[2] Pereverzyev, Vladyslav. "Immediate loading: principles, requirements, and soft-tissue management." ScienceOpen Preprints (2021).
[3] Bargahi, E., A. Nouri, and M. E. Roshan. "Investigating the effect of immediate loading of implants planted in the cavities of freshly extracted teeth." Dent Open A Open J (2022): 19-25.
[4] Gapski, Ricardo, et al. "Critical review of immediate implant loading." Clinical oral implants research 14.5 (2003): 515-527.