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. Jay says:

    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. Alejandro Berg says:

    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. Jeff Ganeles says:

    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. Anonymous says:

    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. ananda krishna says:

    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. TW says:

    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. André says:

    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. yazad says:

    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. King of Implants says:

    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. satish joshi says:

    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


Leave a Comment:

Comment Guidelines: Be Yourself. Be Respectful. Add Value. For more details, read our comment guidelines. Though we require an email to comment, we will NEVER publish your email.
Required fields are marked *

Posted in Immediate Loading, Restorative.
Bookmark Immediate Loading in the Anterior Aesthetic Zone?

Videos to Watch:

3D Guided Implant Placement

The placement of multiple implants in this case was helped thru the use of 3d[...]

Watch Now!
Ridge Splitting Cases in Narrow Alveolar ridge

This videos shows ridge splitting, which when combined with bone expansion, is an effective technique[...]

Watch Now!
Placement of 4 Implants and Cement-Retained Bridge

The treatment plan was to extract the lower incisors, canines, and lower premolar and place[...]

Watch Now!
Failing Bridge Replaced with Dental Implant Supported Bridge

Ahe patient presented with a failed dental bridge from the upper right canine to the[...]

Watch Now!
Lateral Sinus Augmentation with CGF

Following membrane elevation with the lateral approach, and confirmation of an intact sinus membrane, concentrated[...]

Watch Now!
Titanium Mesh for Ridge Augmentation

The use of titanium mesh is a reliable method for ridge augmentation to provide adequate[...]


Watch Now!
Implant Grafting Techniques: Demineralized Sponge Strip and Tunneling

This video reviews several unique grafting and surgical techniques, including the use of demineralized cancellous[...]

Watch Now!
Mandibular Fixed Screw Retained Restoration

This video shows the use of a surgical guide for a mandibular fixed screw retained[...]

1 Comment

Watch Now!
Clinical Tip for Fixation of a Collagen Membrane

This video provides a clinical tip with regards to the fixation of a collagen membrane.[...]

Watch Now!
Lower Molar Extraction with Graft

Video showing lower left first molar extraction, followed by a socket graft, and then immediate[...]


Watch Now!
Maxillary Bone Reconstruction

This video demonstrations Maxillary Bone Reconstruction using Subnasal Floor Elevation and an Osteotome Closed Approach[...]

Watch Now!
Infection of Lower Premolar: Extract and Place Implant

In this video, the lower left 2nd premolar was extracted due to infection, and implants[...]

Watch Now!