Discussion topic: Immediate restoration increase failure rates?
In my practice the early failure rate for dental implants is about 1%, among which most of them are due to the infection or premature loading based on immediate restoration. Does immediate restoration increase the failure rate? What is your opinion? How can I shape the papillae to improve the esthetic outcome without immediate restoration? I’m all ears. Thank you!
14 Comments on Discussion topic: Immediate restoration increase failure rates?
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Charles Schlesinger, DDS
9/30/2014
Failure in immediately loaded implants comes from the lack of sufficient primary stability, either form poor bone quality or an insuffient implant macro structure. The macro structure of the implant must be able to resist micromovement until biology catches up at 6+ weeks. For sufficient stability to load, I want >40-45N/cm and or at least an ISQ of 64.
If you use an implant designed for immediate load, you can have very high success rates. In my practice we immediately load approximately 85-90% of the time (with the OCO Implant system) with a full size temporary with good occlusion.
Ankur Arora
10/1/2014
In case of doing a immediate anterior bridge, if one of the implant has 30 N stability and other implant has around 15N stability and we splint them together, is that good enough?
CRS
10/1/2014
Nope
Dr. Samir Nayyar
10/1/2014
Hello
I usually use immediate loading implants in my practice. I personally load implants when they can be splinted and the initial torque should be more than 40 Ncm. Loading should be done within 3-4 days. I never got a failure using this protocol.
.Thanks
CRS
10/1/2014
The implant temps are placed out of occlusion or protected to allow osteointegration. If the bone and primary stability is poor then bury them. Provisionalization is done at surgery. Splinting unless it is cross arch stabilization does not help in the long run. It is a gamble. Nothing wrong in allowing the patient to stay in temps while everything heals.
Charles schlesinger, DDS
10/1/2014
Absolutely- if you do not have primary stability, do not think you will get lucky. That is a recipe for disaster. Cross arch stabilization is a whole lot different than two implants splinted together. In the second case, the lateral loads will be magnified by the restoration.
myonphu yip
10/1/2014
All of my immediate restoration cases are following the basic primary stability protocol, which is more than 35N.cm due to the Zimmer unique dental implant design. Infection is accounted for most of the failure cases. So I wonder how can I control the infection factors. Any better idea for infection control or preventive measures??
Thank you for your timely sharing.
CRS
10/4/2014
Did you possibly think that the micro movement may contribute to the infection pumping all the oral flora into the site? Think of a fractured tooth and how it gets infected.;)
mpedds
10/1/2014
Seems like no one is answering your question about delayed loading/restoration of implants. 25-30 years ago all of our implant restorations were completed months after placement of the fixture. In fact, it was standard procedure to bury the implant thus requiring a second surgery to expose the top of the fixture and place a healing cap/abutment of some type.
I have and still do routinely restore cases that come to my office with the implant ready to be restored with just a healing cap. You can develop soft tissue contours in a variety of ways; place wider and wider healing caps and "stretch" the tissue out, place a provisional and add resin to it incrementally over time and do the same thing, make a lingual incision and push the tissue labially to bulk up the contour, etc.
Mike Heads
10/8/2014
mpedds talks about developing the soft tissue. The beauty about immediate implants with immediate temporary crowns on, especially in the anterior region, is you do not have to develop anything, you simply preserve what is there. So if it was right before you started it should be right when you have finished. The other thing is patients love immediate implants as they get their teeth at the same time as they lose their old ones, they get little swelling or bruising and it is one of the biggest practice builders you will ever see.
gerald rudick
10/14/2014
I was introduced to dental implantology in 1967 when Dr. Leonard Linkow came to our oral rehabilitation department at the Hebrew University Dental School in Jerusalem........ he demonstrated how he would do the surgery, and immediately load his blades, screws, pins, etc...whatever he was installing........Dr. Branemark of Sweden came out with the research and protocols at this time and said that we must wait 16 weeks for osseointegration to take place....and this was followed for many years....until people were in too much of a hurry to have their fixed teeth, and the dentists went along with it to please them.
Can you walk on cement as soon as it dries?
Immediate loading requires that no forces are placed on the implants for at least three months........but if you sneeze the wrong way and you accidentally put excess forces on those newly placed implants...then it is a recipe for disaster.....wait until the sidewalk is solid!!!!!! Wait 4-6 months, and you will have more success, and less headaches.
Dr. Gerald Rudick the Montreal dentist who insists on walking on a solid sidewalk
charles schlesinger
10/15/2014
Gerald,
Linkow showed that micro stimulation of the bone will lead to faster healing as long as the loads do not go beyond what the mechanical stability of the implant can take.
Immediate load works. It definitely works in a cross arch stabilized prosthesis and it definitely works with single units if you have an implant that achieves a high initial stability through its macro structure. If i get torque values in excess of 60-90 N/cm and ISQ readings in the 70's at placement, why would I not immediately load? I would say with my current system I load approx. 85% of the time. That is foul contour temporary and final restoration within two weeks. May docs i work with immediately restore at the time of placement if they have CAD/CAM capabilities within their office.
Now you have to be smart, you cannot extract a molar, get high rotational stability(torque) , yet have a large socket surrounding the implant and think you will be able to load. The lateral stability of the implant is nonexistent- ISQ will tell you that and if loaded will definitely fail.
Immediate load is possible and predictable. Come listen to my lecture at the AAID in Orlando to hear more about it.
Chuck
Dr. Gerald Rudick
10/14/2014
Soft tissue contours can be preserved by enhancing the soft tissue with connective tissue grafting, and placing a tissue level healing collar or tissue level temporary crown, that will preserve and shape the soft tissue, but will not allow pressure to be placed on the implant while the respected 16 week osseointegration period is respected.....and this way there is no second stage surgery.
Dr.Dr.Hossam Barghash
10/17/2014
planning teach us that we are individuals with each one has its own needs, bigest mistake to have one plane work for everyone, but of course there is guidelines for planning. second there is a mix in this post between are we talking about immediate implant with immediate loading, or delaying implant with immediate loading, another point are we talking about anterior or posterior , upper or lower, the soft tissue issue is important regarding immediate implantation with immediate loading in esthetic area so we can preserve the soft tissue and papilla of course in case it is present.
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