Immediate Loading with Multiple Implant Placement or "How to Design Visually Appealing Smile"

March 29, 2022
3 minute read

TheLink Editorial Team

Immediate loading is a new and advanced technology that provides patients with attractive, brand new smiles… in just one day. An innovative procedure, immediate loading enables the placement of a full-arch fixed prosthesis on the very same day teeth were extracted, resulting in an aesthetic and functional solution. 

Selecting the most suitable implant, combined with professional dexterity during the drilling stage, the decision to perform immediate loading with conventional or guided surgery, and in-depth knowledge of bone regeneration, prostheses, periodontal conditions, and digital dentistry, are all required to achieve optimal results in immediate implantology. 


Immediate Loading: What you need to know

Immediate loading on multiple implants, also referred to “all on four,” is a procedure that allows edentulous patients to receive simultaneous implant placement in full-arch (upper, lower or both) on the same day of the surgery. This technique uses four implants for the full maxillary restoration – two straight implants, and two angulated implants. It's a simple, essentially non-invasive method that meets pre-established protocols, and provides predictable procedures for your implant placement cases.

As far as possible, this technique avoids the use of bone regeneration by taking advantage of bone properties in anterior maxillary areas. A higher quality bone, together with the suitable implant, allows for higher primary stability. One of the key benefits of this technique is immediate functionality. A temporary prosthesis can be positioned on the same day implants are placed, and patients can enjoy an aesthetic smile, and can eat and speak during the bone integration stage.


Key Success Factors for the immediate loading

Various studies on immediate loading have allowed us to identify four critical factors that lead to successful oral rehabilitation.

1. Surgical Technique 

Primary stability and surgical technique are the key success factors.  Primary stability will depend on the patient’s quality and quantity of bone tissue and, in turn, on bone type, according to the Lekhom et al. classification, were bone types I and II are preferred. Dexterity in developing an atraumatic surgical technique, controlled torque, and proper drill use, all impact creating the ideal location for implant placement. 

2. Hard Tissue  

Bone quality and quantity, together with the healing process, and bone restauration (if required), determine the expected outcome. To obtain optimal bone integration, micro-movements should be avoided, as they effect primary stability. 

Osteoporosis, diabetes, radiotherapy, and smoking, influence the healing process, therefore, every patient should be evaluated individually to determine if they are implant candidates.

3. Implant placement procedure

It's a proven fact that implant features have a direct effect on the end result in immediate loading. Dental professionals should take macro and micro-design, dimensions, and surfaces into consideration, as they help both bone integration with the implant, and the healing process, and result in shorter treatment time. 

4. Occlusal Reliability 

 Occlusal strength and prostheses design are interrelated. In posterior areas, the loading supported by implants is higher, therefore, it's crucial to properly distributee the number of implants. Avoiding an oblique and horizontal occlusal loading, helps optimize bone integration. Depending on the case, a suitable bone restauration, and determining the optimal occlusion type, greatly influence  immediate loading procedure efficiency.

Today, significant progress is being made towards new techniques that ultimately enhance aesthetic results, and offer faster bone integration.

5. Immediate Loading in Edentulous Patients – Benefits 

Immediate loading enables dental professionals to restore full arches with immediate functionality, with the following benefits:

  • Reduces treatment time and the number of visits to the dental office, as implants are placed after the extraction, and prostheses immediately afterwards
  • In most cases, sinus lifting is not required 
  • Recovery time is shorter, as fewer implants are placed
  • Immediate recovery in terms of eating, speaking, and aesthetics, increases patients’ self-esteem

6. Who is the ideal patient for immediate implantation and loading?

Immediate loading is an innovative technique that can be used when there is sufficient bone to guarantee implant stability immediately following tooth extraction. Simultaneous implant placement with immediate full-arch implantology is suitable for a wide range of patients. A patient may need to replace a full prosthesis they've been wearing for a long period of time to improving functionality, or they may have lost all or most of their teeth due to periodontal disease. However, certain criteria must be met to achieve successful immediate loading:

  • A minimum quantity and quality of bone tissue
  • Good gingival, periodontal, and periapical condition in neighbouring teeth
  • Good oral hygiene habits 
  • Sufficient space to place implants 
  • No bruxism
  • Good dental occlusion

There are numerous advantages in an immediate loading procedure, from fewer surgical interventions and shorter treatment time, to reduced soft and hard tissue loss, and ultimately, lower treatment cost. But perhaps the most important of all, is patient satisfaction, as they leave the clinic with a new, visually appealing, and cost-effective smile.