Immediate Loading: Are we lowering the odds?

What are the criteria of immediate loading? According to Prof. Branemark, an orthopedic surgeon, the concept of immediate loading was not acceptable. Even removing the restoration from occlusion brings it into function on mastication. Then comes the immediate denture or fixed/removable hybrid bridge of the entire arch. In that case, the concept of taking it out of occlusion makes no sense. I am familiar with the available literature on the subject, but still the issue remains a mystery in my mind. Where is the science? What do you think? Are we lowering the odds of predictability that were at one point very high?

20 thoughts on “Immediate Loading: Are we lowering the odds?

  1. implant guy says:

    35ncm of torque value….you can immediate load temp crown out of occlusion.

    full arch we are seeing immediate load of final hybrid in 4-5 weeks . Cross arch stability. Of course, depending on initial torque values.

    Implant Rep

    • Isaac Jarsen says:

      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.

  2. Dr. Gerald Rudick says:

    In 1967, while working in the Department of Oral Rehabilitation at the Hebrew University School of Dentistry, Jerusalem, Israel one of the many bright international guest lecturers was a man named Dr. Leonard Linkow of New York………. he gave us a series of lectures on Dental Implants…..nobody in our department ever heard of such a field……he showed us that immediately after his blade implants were inserted, he would fabricate fixed bridges on these blades….immediate teeth!!!!

    About the same time, in Sweden, Dr. Per Branemark developed a protocol for his style of dental implants which resembled screws…and these screw were left buried, fo four months…. not to be touched……..

    As implants started to get some serious recognition around the world, the dental profession took the philosophy of Dr. Branemark, as being something that came directly from the Bible or Torah…….and chastised Dr. Linkow for his philosophy of immediate loading……

    That pendulum which was so far to the left against immediate loading, gradually shifted to the right…….. where today, many people think that it makes no difference whether we wait a few months before loading the implant, or load it immediately.

    Both of these pioneers had valid reasoning…… both techniques work….. but the individual dentist placing implants, must learn to decide in which situation will immediate loading be successful, and must take into consideration a lot of factors… and then make up his/her mind on which route to travel.

    • Isaac Jarsen says:

      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.

      • DrG says:

        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.

      • Raul R Mena says:

        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.

        • Paul says:

          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?

          • Raul says:

            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

    • Bruce Smoler says:

      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.

  3. Dr. Gerald Rudick says:

    My dear collegue Isaac Jarsen,

    Dr. Linkow in the earliest days, was making the blade implants himself, from sheets of surgical grade pure titanium…..not titanium alloy which has proven to be a sturdier metal.
    Your comment “Today all implants are made out of titanium” is absolutely not correct…..Have you heard of Zirconium implants, and other material as well?
    Whatever materials are being used to make dental implants today will become something of the past in the not too distant future….teeth will be replaced with genetically engineered autogelous natural teeth.

    I hope you and I are around when that happens, and I will certainly like to meet you in person and invite you for a very fine glass of wine.

    • Isaac Jarsen says:

      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.

  4. James Row DMD says:

    pretty good book out there by quintessence publishing entitled Immediate Loading – A New Era in Oral Implantology; worth the 300 bucks; even still I don’t believe everything I read; hey Isaac, dr rudick has been around for a while – how about you? if you really wanna impress everyone, after you’ve had that glass of wine with dr rudick, let’s see you walk on water pal.

  5. yosef k says:

    I find it hard to believe that we are discussing this. Dentists all over the world are doing full mouth rehabs with immediate loading . Results equal and sometimes surpassing delayed Loading . Wake UP ITS 2017

  6. Paul says:

    How is one to explain the concurrent acceptance of osseous integration and immediate loading? If the concept of osteointegration and the proposed time of 4 to 6 months for the process to reach maturation is correct, we should than explain bone physiology during immediate loading. Does immediate loading speed up or delay osteointegration or is it one of those things that works and we do not know why. In orthopedics immediate loading has been practiced for a long time. Perhaps there is an answer but it didn’t trickle down to dentistry.

  7. David says:

    Doctor Rudick words are true:
    -Dr Linkow is the real father of oral implantology: have a look on his books, with a lot of documented cases: titanium, screws, and even some osteointegration before the swedes.
    -Blades or subperiostals work fine, they are simply more difficult to use.
    – Without Linkow, Tramonte, Dahl and so many others there would never have been a Branemark, and we still be doing complete dentures everyday.

  8. Zach Papadakis says:

    1. Delayed approach
    2. Immediate placement
    3. Immediate placement with immediate temporization
    4. Immediate placement with immediate load

    Can you really have a complete implant practice without knowing when to apply all 4 protocols?

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