Osseointegration: Affect of prosthetic procedures during the healing period?

What implant system?

Some implant systems advertise shorter times for osseointegration, but you have not specified the implant system you would be using. If manually screwing and unscrewing a healing abutment affects the osseointegration of your implant at 8 weeks, then you have no business attempting any procedure that early. Follow the recommendations of your implant system.

Premium treated implant surfaces should be fine. RBM only should probably wait a month.

Dr Boudet is absolutely correct, in that you should check with your implant system protocols, the safest and best advice. Remember bone quality D4 vs D3, D2 , bleeding site , tissue thickness , implant type, your technique ( irrigation copious), osteotomy size and position, , future occlusal load /scheme all play a role, Also check your 2d X-ray in 10 weeks to see if less/no radiolucency around fixture threads, then wait ...Sometimes I will look at my x-ray and wait another month or two and override my 3 to 4 months protocols for exposure of fixtures just to give the bone integration more time ( systemically compromised pt , smokers, or immediate placements) By the way smokers, you will get failures even after 6 or 10 years of successful integration , all of a sudden ( fibrous encapsulation) I’ve had to redo some cases. For instance with osseodensification using Versah’s , Densah burs you can load in eight weeks with ideal situations . My question to you is , if you are going to load on the 12th week , why are you taking impressions on week 8, seems like you already have a healing cap , you are not uncovering( cover screw) the fixture to allow soft tissue contours to form... so take impressions /scan on week 10 , that gives you two more weeks , I’m almost sure that if all things were ideal , you should be fine loading on 3rd month for mandible , but we need to see xrays to confirm and clinical assessment ( photos, mild probe, palpate tissue, check all looks happy,healthy, no inflammation) around fixture. Can get an ostell mentor or Penguin ISQ measuring device to measure integration values, to be sure too. (I think the second week is the worst time to fiddle w fixture , that is when native bone is being remodeled around implant w new bone ) but not 100 percent on that ,I would ask my more learned colligues to elaborate)

You probably will be ok, but what is the rush?

Don't confuse frictional stability [ i.e. like a screw in wood] with osseous-integration. Know the physiology. Just because you have great stability doesn't mean the fixture is integrated. I agree, what's the rush. I routinely give my fixtures 3-4 months. I go faster if it's a super-model type that needs her central replaced like ... yesterday. I have had two failures that I know about in 30 years!

Thank you for the opinions, and patience! Finger forces (for healing abutments and impression copings) I estimate much lower than 10N. Forces during prosthetics is lower compared with screwing in the implant abutment (I set implant motor to 30N) or during mastication? If touching the healing abutments before 3 months adversely affect osseointegration, then prosthetics has to wait 3 months. Does it follow that measuring ISQ have to wait 3 months as well?

Like always...very good comments and suggestions..... the message is " what is the rush?" Give the Osseointegration process time to achieve proper implants stability...you will sleep better......

La estabilidad primaria tiene reglas que limitan el torque para evitar que sea excesivo. Por eso es recomendable ,segùn algunas marcas , que no pase de 40 N cm , mientras otras aceptan un torque mayor , refiriendome a la inmediatez de las cargas. Pero hay implantes que no sobrepasan los 18 Ncm cuando se instalan y si se dejan oseointegrar sin colocar protesis provisionales encima que les transmitan las cargas , despuès de 3 o 4 meses, finalmente pueden resultar exitosos. En conclusiòn , lo seguro o mas seguro es esperar el tiempo recomendado para que la oseointegraciòn se produzca. No olvidar que del apuro , solo queda el cansancio.

I have patients that want implant crowns placed earlier and they quote me articles from dentists who claim to do all of their crowns the same day. I tell them this. You cannot predictably rush biology. It would be like if you were pregnant and so excited to have your baby that instead of waiting for nine months you elect to have a C section and your baby at 6 months. The baby will possibly survive but there may be serious complications and consequences. They get it immediately.