Immediate Loading Implants

 Immediate Loading Implants:

Several classifications of implant loading:

 • Immediate occlusal loading refers to full functional occlusal loading of an implant within 2 weeks of placement.

 • Early occlusal loading refers to functional loading between  2 weeks and 3 months of implant placement.

 • Nonfunctional immediate restoration refers to implant  prostheses placed within 2 weeks of implant placement  with no direct functional occlusal loading

• Nonfunctional early restoration refers to implant prostheses delivered between 2 weeks and 3 months from implant placement.

 • Delayed occlusal loading refers to the restoration of an implant more than 3 months after placement.

Immediate Loading for Single-Tooth Restoration

•  Studies of single-tooth restoration and immediate loading have shown good success rates. 
• on these single-tooth restorations placed into immediate occlusion via provisionalization with success rates similar to those implants restored with light or no occlusal forces. 
• The presence of a provisional  crown throughout the healing phase,  which allowed the sculpting of the interdental papilla and the attached gingiva. 
• Given the recent advances and research in this area.However, the immediate  loading of a single-tooth restoration is clearly a viable option  for  patients.

Immediate Loading of the Fixed Prostheses 

•  Research in the area of fixed or multiple-tooth replacement with immediate loading has been divided into prostheses  placed in the mandible and those placed in the maxilla. In  the early studies of mandibular multi-tooth restorations with  immediate loading, one technique placed additional or interim  implants to initially support the prosthesis while the remaining implants underwent the healing phase. 
•  In the edentulous or partially edentulous maxilla, significantly more implants must be placed to obtain primary stability of an immediately loaded prosthesis. Although many studies have suggested a requirement of 8 to 12 implants, several studies have shown similar success rates with 5 to 8 implants.The literature debates, with varying results, the surface morphology of implants best suited to placement in  the decreased bone density of the maxilla.
• Immediate loading in both the edentulous or partially edentulous maxilla and mandible is a viable treatment option. 

Immediate Loading of Over-Denture Prostheses 

•  No studies exist that display true immediate loading protocols  for over-denture prostheses as defi ned earlier. However, there  is support for early occlusal loading with over-dentures. True  immediate loading in these cases may not be possible due to  the need for prosthetic development of bar attachments in many instances. A recent study placing over-dentures into occlusal loading at 4 days supported by a bar system showed  high success rates. 
• Early functional loading in these studies referred to a  protocol usually consisting of implant loading at approximately 3 weeks with either a ball attachment or bar-clip assembly. Immediate early functional loading referred to placement  of the prosthesis within 5 days. In the studies that attempted  the earliest functional loading the bar-clip attachment was the restorative method of choice. 
•   The majority of the opposing dentitions in these studies were complete dentures and some implant-supported prostheses; there was little difference in success rates between these opposing dentitions. 
• Studies have also suggested that implants for early loading with over-dentures should be splinted with the bar-clip  attachment to prevent axial rotation and micromotion. However, given the success rates with early loading of ball  attachment implants it cannot be factually stated that splinting these implants is a requirement for success. 
•  A flapless procedure was done with the placement of six one-piece, single-stage implants from which an immediate impression was taken for a bar constructed that day, passively placed to support  a clip-retained full lower denture. 

Immediate Placement and Loading of Implants in Extraction Sites 

• The overall reasoning behind immediate restoration of these implants is to aid in restoration of soft tissue aesthetics by gingival contouring as well as removing the need for temporary removable  prostheses. 

Flapless Dental Implants

Flapless or incision less or minimally invasive in combination with dental
implants.

• Current literature with regard to the efficacy and effectiveness of flapless surgery for endosseous dental implants is quite favouring.
• The available data on flapless technique indicate high implant survival overall(approximately 98.6%)
• In the late 1970s, Brånemark established the use of extensive surgical flaps to visualize the surgical field during implant surgery.
• However,flap elevation is always associated with some degree of morbidity and discomfort, and requires suturing to close the surgical wound.
• Surgeons use either rotary instruments or a tissue punch to perforate the gingival tissues to gain access to bone.

Flapless surgery has several potential advantages,
including
(1) Reduction of complications at the patient level, ie, swelling and pain,
(2) Reduction of intraoperative bleeding,
(3) Reduction of surgical time and need for suturing,
(4) Preservation of soft and hard tissues, and
(5) Maintenance of blood supply.

Despite these advantages, the flapless technique also has several shortcomings.
These may include
(1) The inability of the surgeon to visualize anatomical landmarks and vital structures,
(2) An inability to ideally visualize the vertical endpoint of the implant placement (too shallow/too deep),
(3) Decreased access to the bony contours for alveoloplasty .
                                                                     Pre Operative

                                                                      Occlusal View

Intra Operative -Minimal /No Bleeding

After Implant Placement

Occlusal View

Temporarization

Significant reduction in immediate postoperative discomfort, duration of discomfort, facial edema, and the use of analgesics when flapless surgery was performed flapless surgery may have benefits in decreasing patient discomfort in the immediate postoperative period.


Visit Us On : http://www.acdeimplants.org/
For Implant course mail us on: acdechennai@gmail.com
For Implant Treatment :dr_mrgvl@yahoo.co.in