Is Immediate Functional Loading Too Risky?

A recent report by the Millennium Research Group, stated that though the proportion of dental implants delivered in a 1-stage method was 60.8% in the first quarter of 2006, whereas immediate functional loading (IFL) was practiced in only 9.0% of all dental implant procedures.

Millennium comments that despite the potential benefits to patients, “the adoption of immediate functional loading (IFL) has been sluggish because of practitioners’ fears of implant complications and failure.” In fact, some surgeons maintain that excessive stress on the dental implant before sufficient osseointegration of the implant in the jaw often leads to implant failure. What are your thoughts on immediate functional loading? Do you think the procedure will gain more acceptance over time or is the risk of failure too great to warrant use of this technique on a wider scale?

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10 thoughts on “Is Immediate Functional Loading Too Risky?

  1. As a practicioner who applies principles of immediate load I generally seperate them into two categories. 1. totally edentulous awaiting to be totally edentulous 2. partially edentulous.
    The totally edentulous case I find loading has little effect on the final outcome of these cases; were as the partially edentulous case especially when single free standing implants are present are far more prone to failure.

  2. I am surprized… The studies were already done. Statistics were published by our group at NYU and other reputable institutions, and still doubts??? The NYU post graduate implant department has 10 year success data on immediate full arch loading with almost 100% success rate. I also found immediate full arch loading predictable and a great practice buider myself. The surgeons who are uncomfortable with the procedure are correct, however. Immediate loading is very difficult to accomplish. It requires complete collaboration between a surgeon,and a prosthodontist. The procedure also requires a fully functioning lab on premisses to perform the careful reline and emergence profile development for the temporary abutments. Increasingly computer generated design is implemented, but again, any new technology makes the un-experienced uncomfotable. Bottom line is… do not try it on your first, or even second implant case. Get comfortable with smaller cases first.

  3. from theoretical point of view immediate loading of fixture enhanced fibrous tissue formation in the interface of bone and implant that finally could reject the fixture.but practically let see the external resorption that happened after implantation of avulsed teeth,
    because the body could not dissolve the fixture so the implant remain in the site,and the stress accumulate in the area,so when the ossteoclastic activity>osteoblastic action(because of bone loss or infection), in this situation the fixture failure because of bone resorption should be happened.

  4. I personally have done a lot of immediate fuctional loading cases with good outcome, but with slightly worst statistics as with delayed loading cases, My statistic is probably worse because all of my immediate functional loading cases had been done in patients who walk into my office with teeth and they had to be extracted and complete implant supported reconstructions had to be performed, so that those patients can continue with their social life with a minimum change. I agree with the fact that there is much published on this topic, but how many of the cases included in these articles really needed immediate functional loading? has a completely edentolous a rush? Is it important for him to have his teeth in the same day instead of waiting 2 months ? What`s the bennefit for him, I still can`t figure out why they need IFL. In these cases who has the rush the patient or the dentist? I think we need more cientifical background on the outcome of this techniques in patients who really need it, not in the easy cases who really don`t need a more complicated and costly procedure.

  5. Yes IFL do work but,not all the cases are suitable for IFL.
    Befor deciding for IFL following factors should be considered .
    1,Proper patient’s selection
    A,Good quality and quantity of osseous support for optimization of implant’s size, design and locations and numbers.
    B,Proper occlusion.
    C,Abscence of parafuntional habits.
    D,Good oral hygiene.
    D,Genuine necessity for IFL.An elderly patient wearing removable for last 25 years may not want to have extra hassel and expenses of IFL.

    2,Proper training of clinician as well as lab technicians.

    As far as single unit is concerned IFL is not advisable
    rather immediate restoration off the occlusion is prudent thing to do.

  6. While it is fine to quote studies on immediate load from unversity based programs, most of them involve a single implant system and specific numbers/arch placement. Clinicians then extrapolate these findings and apply them to other implant systems and less than adequate loading protocols, resulting in a higher than expected failure rate. If you plan on doing immediate load, look at the macro-architecture of the implant body. Is this architecture more resistant to displacement in the early stages of healing? What type of surface treatment does it have and will it speed bone deposition? Sometimes, implants that heal quickly may not be the most stable in extraction type defects where a substantial portion of the osteotomy is NOT in contact with the implant surface. And STOP listening to implant company hype. Older designs are engineering based, not biologically based, and are NOT appropriate for immediate load cases.

  7. Had 3 2.3 minis to hold bottom denture .center failed .Should I replace with same mini this time only this time use a coarse thread? should I put in a sugrical 3.2

  8. Four or five minis work much better than three. Too much load on a single center-placed mini most of the time. I would set two more minis with diameter and length determined by bone density, width, and depth, on both sides of the failed site, and then do a rebase of your denture with the implant housings set by the lab during rebase for strength. Also I have had much success with setting two additional implants distal to the mental foramen if bone allows. The more minis, the more implant surface area contacting bone, and the more stable the denture so movement isn’t as likely to cause failures.

  9. I’m just finishing Arun Garg’s implant continuum right now. They’re teaching that if the cortical plates are close together you can use a mini more successfully. If the cortical plates are futher apart use regular diameter implant and allow time for integration before loading. The idea is that the close cortical plates will better support the minis but predispose them to failure if the cortical plates are further apart. This is what they’re teaching.

  10. pl provide a comparison between immediate functional loading and immediate non functional loading of endosseous root form implants for partially as well as completely edentulous cases

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