Immediate Loading: Determining Primary Stability?

I did my first extraction and immediate dental implant placement case on tooth
#15. It was a broken down, non-restorable tooth with no apparent periapical
infection present.

How do you determine if you have adequate primary stability after you have placed the dental implant? I am concerned that I may not have engaged enough apical bone to have a good primary stability.

The implant did engage the mesial and distal walls of the socket but not as tightly as I would have liked. The remaining gaps between the dental implant fixture and socket wall were packed with Bio-Oss. Any thoughts would be greatly appreciated. Editor’s Note:

“The findings of the present study indicate that primary implant stability is a prerequisite for successful osseointegration, and that implant instability results in fibrous encapsulation, thus confirming previously made clinical observations…”

Lioubavnia-Hack N, et al. Significance of primary stability for osseointegration of dental implants. Clin Oral Implants Res. 2006;17:244-250.

6 thoughts on “Immediate Loading: Determining Primary Stability?

  1. Alejandro Berg says:

    I allways say: Whenever in doubt, abstain….
    meaning if you are an experienceed surgeon, you know when the implant has engaged bone and is stable so it can be loaded inmediately.

    If you have doubts then dont… maybe it will work anyway but you wont have peace of mind for the integration period(that is the worst).
    If you want a more scientific approach you can buy an ostel instrument that for a hefty sum of money will tell you what is what with a good degree of certainty.

    Are you using implants designed for inmediate loading?

    A personal note… in a 2 or 15 there is no real reason to do inmediate loading… nobody looks that far back and the bone quality is really bad most of the time so DONT, just a little friendly advise.

  2. Marwan Assaf says:

    Bone quality in area of #15 is normally poor as compared to other areas. I would have pulled the tooth and grafted the site with DFDBA bone graft and waited for 6 months before placing the implant.

  3. Pedro Peña says:

    Dear friend: if you want to be succesful limit your immediate postextraction implants to the frontal area meaning from canine to canine.
    Tooth 15 means second right bicuspid or second left molar? in fact both locations are wrong to do an immediate postextraction implant not only becouse nobody looks so far but becouse the floor of the sinus is normally close to the apex od the tooth and your implant must go at least 3 mm deeper in the basal bone in order to achive good primary stability.
    By the way the easiest way to asure good primary stability is the relationship between insertion surgical torque (35-40 N/cm measured with a torque wrench device)and BIC and RFA values.
    Grafting the gap with Bio-Oss is the right decision.
    Good luck.

  4. IA says:

    Primary stability is the same as mechanical stability. Immediately after placement the stability will consist of only mechanical stability.

    With time the mechanical stability will go down and be replaced by biological stability (osseointegration), also called seconday stability.

    An osstell instrument tells you exactly how stable the implant is, the cost is 2499 Euro.

  5. laxman says:

    #15 is the excellent site for immediate extraction and implant long as the crestmodule of the implant bordered by the bone and implant final level should be just below the surrounding bone there is no problem of primary stability and other words the implant should hide in the socket and bordered by the bone eventhough intimate contact need not be there there is no problem. only mesio distal walls were engaged with implant it does’t matter about the primary stability. ideally immediate implant should escape all the loads coming on its head.not only the bone contact the surface tension of bloody environment in the socket will help in retaining the implant thus will lead to future integration


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