One-Piece Implants: Progessively Load? Cross-Arch Stabilization?

In general, single one-piece implants can be temporized immediately if adequate primary stability is achieved but should be kept out of occlusion in most instances. The concept of progressive load, while interesting as an engineering exercise, is too ambiguous to apply clinically. Multiple implants, however, are another matter especially if they can be bilaterally splinted in a full arch application or protected from lateral forces by tooth directed incisal guidance in segmental application.Under such circumstances, immediate loading can usually be applied in a ery predictable manner. I prefer Zimmer's One-piece implants for immediate provisionalization because they come with premachined margins and snap-on components, even for angled impants. This allows for no preparation and easy handling. Hope this helps.

I personally would not advice on connecting a single piece or any implant with natural tooth for 3 units bridge. Better place two implants if clinical case allows it. Although, you will find auhtors writing positively about splinting implants with natural teeth, connecting a mobile tooth with "immobile" osseointegrated implant is not sound alternative from biomechanical standpoint.

One piece dental implants or OPIs are usually of small diameter, 3mm or less. If the insertion torque is more than 35ncm, immediate loading is usually successful. Because of the smallness, there is corresponding less trauma to the bone which heals faster and it follows that osseointegration will be more rapid. A high primary stability due to the 35ncm or more torque will resist excessive movement and allow optimal microscopic movement for healing. In addition the smallness allow the surrounding vital bone to have overwhelming advantage in overcoming the healing challenge.

I think ther is more than one point to be answered but let me start with immediate loading in general.first of all this is wrong terminology cause actualy what we got is immmediate esthatic ,i think even if we have absolute primary stability (prefer to call it healing stability) no one can say from the day 1 we can histological see a healed surface of bone around implant ( I think for every one working in the field of implantology should understan the physiology of bone healing aroun implant) the more recent concept even in delayed loading is also gradual progressive loading cos the crestal bone is still not well mineralized ( babys dont walk from day 0) regarding connecting implant to natural tooth , you have to know that failuer star with cement of the crown of the natural tooth, cos the tooth well move & the cement well be the weakist link, the timming when this is going to happen depened on the degree of mobility in the tooth .

Dear Collegues, please let's define what we are talking about... Dr Barghash is correct. If we're talking about immediate restoration of a single tooth in the anterior region, which I believe is what the title is describing, then we have to remember that all the research by P. WHorle, and D. Tarnow for anterior teeh was ALWAYS OUT OF OCCLUSION! SO loading has never been discussed for anterior single teeth. Immediate Loading had only been researched when talking about full arch restorations and then , these restorations were "cross arch stabilized. I believe this title should be changed because we're already confused with the terminology and this title is making it worse. Just a side note. I personally have never seen, defined, measured or understood "progressive loading" as a clinically existing reality. It is a term that is used in papers, research and discussion. BUt I do not believe it exists... Am I the only one who feels this way??? Either your in occlusion or your out of occlusion! and finally connecting implants to teeth is what you do when we're in trouble, we would rather not treatment plan that as an option for any patient. Hope this helps, Dr Dean

Progressive loading is defined as loading the implant gradually until full biting forces is experienced. Even if the implant abutment or temporary prosthesis is out of occlusion, there are still forces acting on it. Forces from the tongue, liquids sloshing about in the mouth and food impinging against it during eating. These forces is transmitted to the bone and provided they are not too excessive, i.e. the challenging forces do not overwhelm the physiological healing powers of the bone of the individual, the bone will respond by becoming stronger around the implant. Meaning more calcification in the immediate periphery of the implant. Over 40 to 60 days, the implant will be osseointegrated sufficiently to be loaded fully occlusally. Hopes this helps.

I completely agree with Dr Kfc's very good notes about a shorter-time-healing for narrow implants and that "out of occlusion" does not mean out of loading.

dear dr. Vafiadis loading does not only mean occlusion , the material of the prosthesis & quality of food also count.so by progressive gradual loading means that we start the secned prosthetic stage with acrylic crown not porcelin,I know that many Doctors start with the definit prosthesis , but actualy acylic crown is more resiliant so ti transmit the force gradualy to the implant. Food quality is one of the important point to be considered. usualy the patient is happy when he/she got the prosthesis & want to try it with all kinds of food.we have to tell the patient to start gradualy with soft diet .( occlusal forces increase with hard food). we give the patient a list of food category with time table which is different according to the implant postion & patient bite force. changing the food quality gradualy = gradual progressive loading by following the above program the result show no crestal bone resorption in the first year after loading. hope this explain the concept of gradual prgressive loading

I understand the concept of food and tongue forces, my problem is that this terminology is not clear for clinicians to understand and therefore is grossly mis-interpreted by many collegues. "loading" is just a incorrect term that leads the novice into thinking he can load it softly. It has never been measured and when teaching resident and other professionals this is a very vague desciption when talking about Occlusion and in the same sentence explaining food contacting the implants and the bone reacting to that pressure. Please site one article that proves that that exists. Becasue I have not found it. It is a theory at best and maybe it should be called "Progressive pressure". Somebody come up with another term becasue during many educational courses I am asked to explain it and the term is just misleading and cannot be measured which lends itseld to MISuse by many. Again I understand it and many people unstand your definition , but it is being interpreted in an incorrect way and may cause early failures. Thanks Dr Dean

I do agree with you totaly that ia it is very important to have the right terminology,also we have to differenciate between the term (concept) which mean idea or rational and the word (technique) which mean the application of the rational.from this point of view the term immmediate loading is totaly wrong because it lack any rational behined it regarding bone healing . gradual progressive loading has agood rational because it goes with the physiology of bone healing which I applied in delayed loading. the point of confusion well be when using the word immediate laoding but gradual progressive this is was a way to try to overcome the high failuer rate happened after immediate loading . the point regarding when to load the implant is based on achivieng a rigid primary stability & the only judge is by measuring it(RFA)& as ageneral rule whenever we decide to load the implant the concept of gradual prgressive laoding must be applied

Cross arch stabilization is a perfect concept and it directly derives from the principles of orthopaedic surgery. It makes immediate load so much safer. Other than orthopeadic surgeons, we dont sell single "fracture plates" fixed with screws, but we sell 12-unit-briges (piece by piece) on the implant and this is why we driver the larger & newer Mercedes Benz, compared to those poor colleagues.

I am using one piece dental implants for more than 8 years It does have it's limitations. But as time pass we learn how to find the answers. My database demonstrates that more than 85% of my patients are treated with one piece dental implants. at my private practice my patients are reffered for this type of treatment, because their life style (social life) does not allow them to be with any type of removable denture. my clinic is limited to dental implants and I do believe the future of dentistry would be one piece dental implants. S N Nik PhD (Dental Implantology, UK)