Many factors explain the popularity of immediate loading protocols: patients appreciate being able to shorten the overall length of implant treatment and reduce the number of procedures they must undergo in order to obtain fixed implant prostheses.

Despite the broad body of evidence validating the predictability of immediate loading in carefully selected patients, some studies have reported higher failure rates with an immediate-loading approach, as compared to a staged approach for implant placement.

Crucially important to immediate occlusal loading is achieving high primary implant stability. Primary stability must be sufficient to allow implants to resist micromovement until adequate biologic stability has been established.

In light of such research and the author’s 25 years of clinical experience with immediate loading, a protocol for ensuring high primary stability for immediately loaded implants has been developed. The protocol includes:

  • identifying the quality and quantity of bone for each patient
  • using an implant with optimal macro- and micro-geometry
  • paying attention to biology and biomechanics
  • undersizing osteotomies and preparing these precisely for placement of tapered implants
  • matching the drilling sequence to the bone type
  • understanding the surgical instrumentation
  • understanding the instruments available for determining primary stability at the time of implant placement

Learning objectives

  • the most predictable clinical indications
  • the best macrogeometry to achieve an optimal primary stability in different bone qualities
  • the correct sequence for undersizing the osteotomy