Immediate vs. Delayed Loading?

Dr. Cal. asks:

I have just read: Immediate versus delayed functional loading of
implants in the posterior mandible – A 2-year prospective clinical
study of 12 consecutive cases (Romanos G., Nentwig G-H. Int. J. of
Periodontics and Restorative Dentistry; 2006:26:459-469
).

The bottom line here is that after 2-years in the posterior mandible, there was basically no difference between the dental implants which had a 3-month osseointegration followed by restoration versus immediate loading of the dental implants! In this study, 3 dental implants were placed in the posterior mandible and splinted together. Have any of you out there done this sort of immediate load and what were your results? Do you see a difference? Any thoughts on immediate vs delayed would be appreciated.

5 thoughts on “Immediate vs. Delayed Loading?

  1. Would not base any thoughts from that study with such a small sample size. More and more information is coming out that immediate loading has about the same success rate as the traditional route. However, no great consensus on when immediate loading should take place ? For example, immediate load an implant that is stable at only 5 Ncm ? Load at 20Ncm of initial stability ? Temporary completely out of occlusion and all excursional interferences or load in light axial occlusion only? Osseointegration has similar properties to healing of fractures. Movement leads to non-union and fibrous unions. So unless I can be sure movement is eliminated or very minimal, I don’t immediately load.

  2. I have good success with immediate “load” in the anterior and selected esthetically demanding premolar sites. The protocol is if the implant has primary fixation of greater than 30-35Ncm then the implant can be immediately temporized. The temp is out of occlusion and no lateral or protrusive contact. The patient is on a modified soft diet until the osseointegration is complete (6 months in maxilla and grafted bone, 4 months in mandible). I personaly do not feel comfortable temporizing 1-3 posterior units because it is hard to control the load. Moreover, the implants tend to be in a straight line so there is no cross stabilization. Patients will inevitably bite on the temporary and the posterior mandible experiences greater force compared to anterior sites. If however there is cross arch stabilization with 6 implants for example, I feel comfortable loading the case because of the splinting effect and the even distribution of the masticatory forces. I think that this is a safe protocol and I realize that there is research that supports immediate loading even in the posterior mandible and maxilla.

  3. Somborac published a paper in the October 2002 issue of ORAL HEALTH titled “Implants For Overdenture Retention; Immediate Insertion Treatment Compared to Delayed Insertion Treatment”. 62 patients were treated for overdenture retention with a total of 186 implants and followed from March of 1996 to March of 2002. The survival experiences of the two groups were compared with the Kaplan-Maier method. The survival of the implants in the Delayed Group was 94.8% versus a 98.9% survival of the Immediate Group. (Chi-square = 1.2; p = 0.27).

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