Dental implants have had tremendous improvement since their initial introduction into clinical practice. With ongoing advances in implant technology and materials, better data emerge to allow shorter time between placement and restoration. This allows the restorative dentist and surgeon to provide improved treatment options to patients. Most evidence that exists supports the practice of immediately placed (after extraction) and immediately loaded implants. Additional high-quality studies are still needed to develop specific guidelines for a standardized approach to immediate rehabilitation.
Key points
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Immediate placement and immediate loading of dental implants is a safe and successful option for replacement of teeth in newly edentulous areas.
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There are specific conditions in which immediate placement and immediate loading are not recommended, including bony wall defects, poor bone quality, and acute infection.
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There are multiple techniques that practitioners can choose from when deciding to place immediate implants with immediate loading, all of which can provide more convenience for the patient and practitioner.
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Immediate implants can be performed for single-unit restorations in partial edentulism, or for fixed prostheses in complete edentulism.
Dental implants are the preferable method of rehabilitation of partially or completely edentulous patients. Traditionally, implant placement follows a nonloading period of 3 to 6 months for osseointegration. However, in recent years, the viability of immediate implant loading has been researched in an attempt to shorten the waiting period for osseointegration.
Immediate loading is defined as a restoration placed on the endosseous implant structure within 72 hours of placement. Multiple prospective studies and systematic reviews have shown that immediately loaded implants successfully integrate at least 95% of the time. This integration depends on several factors: surgical technique, primary stability of the implant, quality and quantity of available bone, minimal postoperative occlusal loading, and patient selection. Patients with comorbidities, such as uncontrolled diabetes, osteoporosis, heavy smoking, immunocompromise, and malnutrition, may experience delayed healing or poorer outcomes.
Immediate-loading implants are generally versatile and can be used in various locations and conditions, such as a healed edentulous area, a fresh extraction socket, posterior maxilla in the area of the maxillary sinus, and a narrow-ridge anterior mandible. To maximize the potential for success, multiple factors must be must be considered when treatment planning. In an ideal situation, an implant would be placed into a well-healed ridge with sufficient bone quantity and quality, in a healthy, nonsmoking patient. This, unfortunately, is not always the case, and preoperative planning is paramount for optimizing the outcome. There are specific indications ( Box 1 ) and contraindications ( Box 2 ) for immediate implant placement.
