Immediate Loading in the Anterior Aesthetic Zone?

Dr. Polson asks:

I have discussed a number of dental implant cases where I want to do a one-piece, single stage, immediate provisionalization at the time of tooth extaction in the anterior aesthetic zone.

My periodontist will extract the tooth and place the dental implant. The
patient will then come to the office for provisionalization. What has
been you experience with immediate loading dental implant cases like this?

10 thoughts on “Immediate Loading in the Anterior Aesthetic Zone?

  1. Unless extensive bone grafting is required, I have made a practice of immediate provisionalization of all single implants in the esthestic zone. It is critical that the implant not be loaded and not have any occlusal contacts. Patients are cautioned against incising with the implant.

  2. Dear Dr. Polson:
    Even if you need to graft you can do inmediate loading.
    My recomendation is to make a flapless surgery, use a temp-stent(the temporary with wings that serves as surgical guide),create a Fresh Extraction Socket, place the implant , then graft without flap if needed and the place the temp. My experience with this technique is good.
    I dont use one piece implants, but if you are going to do inmediate loading, remember to use an implant that has big threads(it will be stable during the osseointegration period).
    Best of luck.

  3. Before doing this procedure, you should make sure that the patient can tolerate 1/2-1mm recession on the direct facial as this is a very common occurance. If esthetic demands are high and a perfect result is required, then think twice about immediate placement and immediate restoration. You lose most of the ability to correct for bone or tissue deficiencies with this plan.

  4. dear colleague, the presurgical issues need to be assessed comprehensively to avoid problems: 1/does the patient exhibit a high smile line,this is a concern for recession of the facial tissues as pointed very finely by dr Ganeles before
    2/ what is the patient’s biotype, chances of recession are higher with thin scalloped tissues vs thick fibrous
    3/ what are the patient’s expectations in terms of aesthetics; the higher they are, the more risky for you to obtain the results without compromise
    4/ the reason for extraction should be clear- immediate loading and infected periapical areas mignt not be good friends nor the loss of facial bone from perio lesions,in these cases , more conventional approaches could be the answers
    5/ temporisation and patient cooperation are the key points too
    6/ these are just friendly advices from a GP placing implants

  5. dear dr polson
    immediate implantation with early function is an extremely challenging situation for the operator in terms of gaining primary stability. as you know the discrepency between the socket anatomy and the configuration of the implant may prevent you from gaining adequate primary stability. if you use a two piece implant you can still convert the procedure into a two stage procedure but if a single piece implant is used you will be commiting to a treatment plan of no return.i feel its better to be safe than sorry. the only advantage i see in using a single piece implant in such situations is that you can get away with the abutment connection which is difficult in immediate implantation with early function cases.
    thanks regards

  6. Bone and soft tissue resorption is extremely unpredictable after extraction. Placing implants immediately is risky in case of demanding esthetic. There is no convincing literature evidence to support this, and my own experience over the years steers me towards towards delaying implant placment.

  7. Dr. Polson

    I wish some publications about immediate loading for criteria for sucess. And a program about biomecanical properties. Thank you!
    P.s. Brazil

  8. Hi there,
    did a case in a 77 yr old male put in 3 biohorizonz implants for a later ber overdenture.
    The guy broke open 4 out of 6 sutures due to over zealous gargling.
    Now the wound refuses to heal even though freshened up.
    Any suggestions?

  9. Yazad,
    If the wound is not closing up, most likely yo have dead bone that you need to remove. If you mean the wound has a dehiscence over the cover screw, then you can leave it alone or flap, refresh margins, use CT graft to cover.

  10. Flap opening could be from many reasons, including flaps under tension, improper suturing technique,improper type of needle (coventional cutting instead reverse cutting) or suture material(plain gut),very thin flap, too tight sutures etc.
    I think we like to blame patient for any mishap in treatment.
    it takes some time for wound closure by secondary intension.So what is the time frame? Is patient heavy smoker?
    Most probably cover screws may have been exposed.If that is the story, you need not to do any thing, except instructing patient to keep site clean

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