Immediate Implants

Immediate loading is defined in terms of timing as at the same clinical visit as implant placement. With the single‑implant scenario, this is often achievable and will be advantageous in supporting soft‑tissue contour. When considering partial and complete edentulism, the logistics of providing a provisional restoration often dictate a delay from the time of implant placement. For this reason as against any biological basis, “immediate” is most often defined as “within 48 hours.” The term “immediate loading” is reserved for full occlusal loading in at least centric occlusion and “immediate restorations” or “non occlusal loading” for restorations with no centric or eccentric contacts.

Indications

• Traumatically avulsed
• Residual deciduous teeth
• Horizontal/vertical fracture of teeth
• Failing endodontically treated teeth
• Nonrestorable teeth.

Contraindications

• Inability to establish mechanical stability (i.e., inadequate width and/or height of available bone)
• Proximity to adjacent teeth
• Placement of implant outside alveolar envelop
• Presence of infection.

Advantages of Immediate Loading

1. Reliable method for developing soft‑tissue site of single‑tooth restoration
2. Facilitates efficient fabrication of final restoration
3. Reduces time duration until prosthesis
4. More acceptable to patients (than the removable alternative)
5. Immediate functional and esthetic (sculpting of sentimental tissues) rehabilitation of the patient
6. Elimination of second‑stage surgery
7. Adjacent papillae are well preserved contributing to the ultimate esthetic outcome
8. Countersinking the implant below the crestal bone is eliminated, reducing the first crestal bone loss.

Disadvantages of Immediate Loading

1. Unpredictable nature of the results
2. Micromotion of the implant that can cause resultant crestal bone loss or implant failure is greater than with two‑stage approach
3. Secondary infections in the grafted sites and recession in the thin tissue biotype areas