Immediate Loading: Are we lowering the odds?

This issue of out of occlusion sounds a little like building a house and waiting for the foundation to reach the level of the house. Mastication brings everything into occlusion part time. Is part time vs. full time that different in this case? Perhaps it is but there is no support for that claim. There is no argument that there isn’t but this guy does not know of any.

What you are saying is not new to many in America. The blade implants always failed. The blade implants never took into consideration the material they were made from. Most of the time if not always the material was surgical steinless steel. Branemarks discovery was not the blade vs. screw but the material, titanium. Today all implants are titanium. That is number one error in your thinking. Jerusalem is a holy land but there is nothing holy about implants. With the screw came all the options of abutment and the osseointegration concept, and the primary stability and the bone regeneration concept. To compare Branemark’s invention to the speaker’s in Jerusalem idea is like comparing a sword to a gun. Sorry, but your response has no merit and sounds very amateurish.

Branemark was indeed an orthopedic surgeon. Today patients walk immediately on him and knee replacements. Materials change, technology changes, and protocols change over time. Those of us who do mostly implant dentistry realize when immediate loading is feasible and when it is foolish. It's more than torque values and cosmetics. Bone density, patients health, patients home are. Presence or absence of infection, bio type. All these factors play into the decision making tree. The predictability stays the same if you know when immediate loading is appropriate.

As a disciple of Misch early on my career (30yrs and counting), I am cognizant of the difference between fact and fiction: data/science and a clinician's own beliefs/deductions. Even deeper is the difference between retrospective studies and prospective studies. Smarter clinicians who have come before me have moved mountains of testing , research and results showing the benefits of 4-6 implants immediately placed, loaded and in function. These cases have been tracked, evalutead and subjected to the scientific process of peer review and investigation. Bottom line; in your hands, your clinical decisions are what you decide you feel comfortable performing. Belief systems are subject to the ebb and flow of 'pop culture' in Implant Dentistry. It sounds like you are smart enough to choose a path to follow to provide a good service helping your patients live a healthy productive life.

Dear Colleagues, my comment is not in favor or against immediate loading, that is a subject that merits more than a paragraph. Regarding the comment made on blade implants, it could not be further from the truth. I placed many blades 25 years ago and there is no sign of bone lose in any of them. I presented many of this cases at the AAID annual meeting in Orlando Florida. So, did Dr. Richard Hughes. Blades were manufactured with Titanium. Branemark did not discover Titanium neither was the first one using Titanium for dental Implants. Linkow in 1963 developed the Vent Plant root form implant and placed thousands of them, many of them were immediate loaded. So did many of the Italian pioneers. There is no reason for me to despair Branemark, but Linkow was is a different league, a thinker, a doer and fully devoted to dental implantology, that is why he is considered the Father of Dental Implantology. Branemark, demonstrated osseointegration, so did Tom Driskell on his research on Rhesus Monkeys for the US Army. From Nobel Dental Implant System the implant community inherited many cults, all of them guided by a profit motive. They also tried to divide the profession as to whom should be placing dental implants. They main reason that Nobel didn’t favor immediate loading at the time, was for the poor thread design of their Implants. It was originally designed with the purpos of screwing it on a rabbit to demonstrate osseointegration. It has a metal thread design with very small depth on their thread and many stress points. Note the they finally had to change their thread design so they could compete with other companies with a better implant design. I am sure that both of them are now in a very Holly Place.

Raul R Mena Do you have any x-rays of blade implants that were taken as a follow up after placement with some intervals? Would you be willing to share with us?

Yes I do, if you ever visit South Florida, I will be more than glad to share them with you. I am writing a book on different implant modalities, and the publisher prefers for me not to be posting any of them at this time. But as I mentioned, will share them with you at my office. Raul

You are absolutely right that today we have other materials like Zirconia. All things aside, we know that primary stability is important. Obviously we must have encountered circumstances that we compromised with the torque numbers and it worked. That is not enough evidence to call it predictable.Just by virtue of the engineering a blade implant to be able to meet that criteria would have to be forced into the bone by some method and to have some criteria of the force would be impossible to monitor. People tried many ways to stabilize dentures but the concept of replacing teeth one by one is without doubt prof. Branemark's achievement. Any tinkerer can come up with a screw concept because it fits the closest the mechanical familiarity from other industries. People have tried to use stainless steel screws to support dentures, glues of various origins. Let us be truthful that we practice a very mechanical profession, more mechanics than science. That is what brought my post to this forum. We all would like to see some science in what we do and not rely on gut feeling.