Optimal healing time on maxillary implants?

6 months.

We always load at 10 weeks using Osstell confirmation even when there has been a substantial graft with low primary placement ISQ . Research ( Sasaki et al JOMI , 23 vol 5 ) show integration as such at 4 weeks and shows the bone metabolic increase by placement and early loading . Regards Peter

My rule of thumb is six months depending in bone quality at placement. At six weeks the implant is most vulnerable due to change from mechanical stability to osteointegration pretty well established fact. It's just biology six weeks is minimum for fracture healing it is the only way to be sure. You could push the time further to 4 months it is a judgement call. Immediate load, all on four etc rely on the prosthetic management to help with the stabilization that's how bone heals.

I fully agree that for healing in maxillary implants is to be 4 to 6 months depending on bone and general health of the patient.

If I have a good primary stability (20 N/cm2 or more) 4 months. If I have less torque than that 6 months. My experience. There is no concensous.

Generally we wait 5-6 months...longer if large grafts. Why rush ...is my feeling! Maybe I'm old fashioned but our success rate is very high. So why change!

Hi Don , It is not for want of earlier loading but to Improve the bone metabolism which earlier loading brings thus improving the bone quality . The research I mentioned above explains it but metabolism is initially raised by the placement of an Implant which then tails off so an earlier loading stimulates another "spike " in metabolism . Our 5 year pre-loading success rate is over 99% , but use of Osstell is helpful. Peter

Hi Gary , it is case and tooth dependant . But I prefer to be 68 and up.... In the last 6 months whilst using a new material ( Particulate graft ) we have regularly seen in the low and mid 80s which I had not seen before. Peter

Hi All, I agree with Peter Fairbairn and I do something very similar. It is a technique called bone training, I place an implant with transmucosal healing abutment and then wait 6-10 weeks. following this, I place a solid abutment which is considerably shorter than the occlusal plane but will inevitably have forces put on it by mastication and tongue/cheek movement. Following 6-10 weeks of this the tooth can be restored into full occlusion. Whether I do this technique, immediately load or as Peter Fairbairn does depends largely on insertion torque, bone quality & ISQ. I hope this helps, Dean

We have been using Osstell for years to monitor ISQ and find it a really useful tool. In aesthetic areas where we have favourable occlusion, high insertion torque (over 35 Ncm) and good Osstell readings i.e. above 65 ISQ, we will consider immediate tooth replacement i.e. loading on day 1. I agree with Peter in that there is growing evidence to suggest bone metabolic increase by placement and early loading. This goes against the paradigm that any premature/ unwanted loading will cause failure. It would be a rare occasion that I wait more than 10 - 12 weeks before loading max implants, such as when implants have been placed simultaneously with prodigious grafting. Average time 6 - 8 weeks. We actually see an increase in the success/ survival of these implants, which is probably no surprise... as the implants that we have to wait for long periods before loading are usually the implants placed in the most challenging situations / patients. P.S. I am not suggesting loading at day 1 is a good idea for all comers - Just illustrating the point I am making that there is no hard and fast empirical rule you need to employ to work out how long you need to wait. Immediate tooth replacement/ loading is only suited to low handicappers who do high volume of implants and have plenty of experience in this field. Nick

Thanks and good to see Guys , things do change and these concepts whilst new and with more recent research are in fact common sense in the realm of bone physiology. Equipment and newer materials are allowing us to discover more about these protocols . Regards Peter