Early loading at 8 weeks: Should I take a chance here?
This case involves a 60-year old male patient with a non-contributory medical history. I placed the implants in mandibular and maxillary regions, as seen in OPG, at 7 weeks. We had planned conventional loading. But my patient has got some emergency and needs to fly out of the country for good. He is not coming back and is insisting that I load the implants in another week. I have explained the risks. I have done 30 immediate and conventional loading cases. But never early loading. The mandibular implants had good primary stability. The maxillary implant was placed in conjunction with an indirect sinus lift and was torqued to 15Ncm. What do you advise?
4 Comments on Early loading at 8 weeks: Should I take a chance here?
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Peter Fairbairn
3/18/2017
I load all my sinus cases at 8 weeks , and have published a ten case prospective study on that . The Research show that integration is at about 4 weeks ( Sasaki et al , Jomi ) .........infect earlier loading induces a second spike the host bone regeneration ........do you have Osstell to check ???
If not will be fine
Regards
Jaishiv
3/20/2017
Hey thanks for your input. I do not have an osstell. But yes will go ahead with early loading. Any inputs on occlusal scheme for lower anteriors?
Dr. Elijah Arrington III
3/21/2017
I would not load any implant at 15Ncm. You didn't mention the torque on the lower however: I don't see a problem at 35Ncm. If you are not sure about the lower add another implant thus lowering AP spread (No Charge if you have to). Load everything out of occlusion using acrylic matrices. Be careful to watch for lateral and protrusive excursions. I don't see a problem. I don't know if you bone grafted the lower or not, but it looks doable. Make a removable prothesis if you have to, don't be bullied into doing bad dentistry. You are the implantologist!!!!!! Not the patient. You will get sued if you do what they want instead of what you know. That same patient rushing you will sue you for bad dentistry. Our responsibility here is to what you were trained and what you feel comfortable doing. You are the doctor not the patient. I have been in this situation many times and have barely lived to tell about. Thousands of implants later, I do what I have been trained.
Also look into using Versah burs. They give you torques upwards 50 Ncm on Most cases.
comlan Missih
3/24/2017
Loading the implant at 8 weeks should be ok even if the primary stability was 15Ncm. At 8 weeks, implant already has secondary stability and osseointegration has occurred. Looking at your radiograph, you barely have 1-2 mm of the implant breaking through the sinus floor. Case like this, I would not even bother to do transalveolar sinus augmentation.
