Immediate loading of dental implants is nothing new. The beginning of modern implant dentistry was with the subperiosteal implant which was originally described in the 1940s and the blade or plate form implant which both have inadequate long-term success results compared to the root form implants used today. Both these implant styles along with others were immediately loaded so when I started placing dental implants in 1985 that procedure was common.
Immediate loading of root form implants, was first documented in the 1980’s and the question of how many implants to use, in which technique to use in each patient and how much bone was necessary for long term predictability have been key areas of research since then. Lately a popular technique known as the All-on-4® treatment concept, has become marketed and the era of “one size fits all” seems to be back again. The concept was developed and systematically analyzed in the 1990s. It consists of placing four dental implants the anterior jaw, where bone density is higher, allowing a high success rate. The four implants support a temporary fixed prosthesis with 12 to 14 teeth and it is placed immediately on the day of surgery. All-on-4® is a registered trademark of Nobel Biocare. and All-on-Six is a commonly used term for using more implants than what is possibly adequate in the long term with All-on-Four.
Alternative procedures are described in the bone regeneration section of this site. Although this was originally designed for the lower jaw, this technique use quickly spread to the upper jaw and most often we use it in either jaw when a patient has a number of hopeless teeth and wants to avoid a denture.
All-on-Four looks like this:
Application in the upper jaw became evident as well. The most common cases we treat today vary four to six implants per arch depending on what type of teeth will be used for the final teeth, how much biting force a person uses, men create more bite force then women, how much bone remains to use and what type of teeth will appose the implanted teeth.
Description of the procedure
Many patients can not or do not choose to have bone regeneration, some out of health reasons (diabetes and others) others due to time limitations, cost factors and the desire for an immediate temporary result that is more satisfying than with removable teeth.
The treatment concept provides customized denture (bridge) with semi customized teeth (denture teeth) on four to six titanium implants. These implants act as “pillars” to the bridge that supports the prosthetic teeth. This process takes advantage of existing bone, avoiding having to use bone regeneration.
The back implants are angled at 30-45 degrees to avoid compromising the sinus cavity in the upper jaw and the nerve canal in the jaw. This treatment concept owes its name to the applying a dental prosthesis with at least twelve teeth (bridge) fixed in the jaw, based only on four titanium implants.
Advantages of Immediate Loading
- Tests the implants: Prior to final restoration
- Tests the prosthesis of choice: Prior to Final Restoration
- Immediate relief from problem dentures
- Gives patient Immediate Satisfaction
- Less total treatment time
- Helps patients AVOID DENTURES
- Patient Appreciation is VERY HIGH
Disadvantages of Immediately Loaded Implants
- Possibly higher risk in some situations
- Potentially higher costs depending on number of implants used
- Much more technique sensitive than dentures
Examples of Immediately Loaded Implants
View other Patients #1 and Teeth in a Day patient under CASE STUDIES tab
This patient had a number of hopeless teeth. He chose to have an adequately predictable solution of All-on-Four. His hopeless teeth were extracted, the implants placed and the temporary teeth were attached to them at the same time.
This patient had has upper teeth removed, implants placed and new temporary teeth on day one and on day two had his lower arch treated. I find fatigue of the patient and surgical team is minimized by treating one arch at a time.
This patient suffered from a chronic dry mouth and the resulting continued decay on teeth, around fillings and crowns. She considered saving her teeth and having them restored but decided that long term, the replacement with dental implants was her preferred option. She chose the more predictable All-on-Six plan for both arches.
This patient won’t ever have any more decay or need any more root canal treatments
Patient #3 .
This patient wanted the best option available. The final teeth are porcelain bonded to Nobel metal which provides the strongest longest last choice.
More views of these and other immediate teeth and teeth in a day can be viewed in Lower Jaw CASE STUDIES tab