INFORMATIVE ARTICLES
Immediate Loading of Root-form Implants: Two Case Reports 3 Years After Loading
By Robert A. Levine, D.D.S., P.C.
Louis Rose, DMD
Henry Salama, DMD
(International Journal of Periodontics and Restorative Dentistry, Volume 18, No. 4, Pg. 333, 1998)
 Before the principles of osseointegration were fully understood, the protocol for placing endosteal blade implants routinely involved immediate loading of the implants. This technique contributed to the high rate of implant complications and failures early on and was widely criticized by the general dental community. Once the importance of achieving and maintaining osseointegation was recognized, however, new implant designs, materials, and atraumatic surgical techniques were developed to address these early problems. These considerations have dramatically increased the success and predictability of dental implants.
 The original guidelines for achieving osseointegration invariably called for submerging the implant and keeping it load-free during the healing period. The logic was that immediate loading can complicate osseous healing and remodeling at the bone-implant interface following surgery, leading to the development of a fibrous layer between the bone and implant rather than new bone growth and osseointegration. In addition, submerging the implant was deemed to be crucial for preventing infection and epithelial downgrowth. These prerequisite steps led to the standard protocol currently followed for osseointegrated implants, which typically calls for keeping the fixtures unloaded for 6 months following placement in the maxilla and for 3 to 4 months in the mandible.
Protecting the bone-implant interface is still a critical goal in implant cases because the quality of bone modeling and remodeling in the surgical area is the ultimate predictor of the implant's success and survival. Microscopic cutting and filling cones, composed of osteoclasts and osteoblasts, respectively, are responsible for remodeling at the bone-implant interface. It is critical, however, that implants be kept as stable as possible. Excessive micromovement, or movement of the implant surface in relation to the bone, can easily result from premature functional overload of the fixture. This, in turn, can disrupt the early remodeling process, resulting in fibrous repair at the interface rather than osseointegration...
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