Delayed vs Immediately-Loaded Dental Implants: What's The Difference, And Which Ones Are Better? | Ear, Nose, Throat, and Dental problems articles | Body & Health Conditions center

Dental implants are the latest option for replacing missing teeth. They provide the best possible replacement of lost teeth, both esthetically and functionally. A well-planned, well-placed, and well-maintained dental implant can virtually serve its purpose for a lifetime.

Dental implant treatment is remarkably widespread now, but has been around for just a few decades. The protocols and techniques around dental implant treatment are changing all the time and different doctors may follow different ones. The conventional treatment protocol dictates waiting for a minimum of three to six months after the implant placement before a crown can be placed on top of it.

For some patients, this alone can act as a deal-breaker. Patients may be unable to make multiple visits to the dental office or may simply want to get their teeth replaced as soon as possible, especially if the missing tooth compromises their smile.

Delayed-loading implants: What you need to know

Conventional implant surgery is done in two parts. The first part involves placing the implant at the site of a missing tooth. The implant is then covered by stitching the gums over it and is left undisturbed for four to six months. This gives the bone and the surface of the implant time to integrate with each other, providing enough strength and stability to the implant to withstand heavy chewing forces.

The second stage involves exposing the implant surgically and then attaching the prosthetic crown with the help of a screw or cement.

Immediately-loaded implants: What you need to know

This is a relatively recent concept in the field of implant dentistry. This concept has been developed with the belief that the conventional loading protocol was too conservative. Patients did not have to wait to get their "teeth" and the number of visits to the dentist could be dramatically reduced.

Immediately-loaded implants are ones in which the crown is given within 24 to 48 hours of the placement of implants. This is especially useful for replacing missing teeth or broken teeth in the front regions of upper and lower jaws since missing teeth in this area affect their smile and makes them conspicuous.

Are immediate-loading implants as successful as delayed-loading implants?

Traditional delayed-loading implants have been in use for more than half a century. And there is enough data available to show that around 95 percent of implants survive well even 10 years after placement. The immediate loading of implants is a relatively newer concept introduced around three decades ago. Studies have shown that if immediate loading is done after going through proper selection criteria, the chances of success are as good as delayed loading implants.

When are immediately-loaded implants possible?

The immediate loading of implants is only possible in patients who have a good amount of dense bone in their jaws.

If the bone is softer, the implant does not have the initial stability in the bone to support the forces of chewing. In such cases, immediately-loaded implants are not advisable. The lower jaw, in general, has a thicker bone when compared to the upper jaw. So the dentist is more likely to achieve a good amount of strength and stability in the implant to support an immediate restoration.

The most common site for immediate loading implants is in the front regions of the upper and lower jaw. The front teeth are not subject to much of a chewing force and the crowns are made in such a way that they do not touch the opposite tooth. This further reduces the amount of force on the screw and makes it possible to try and achieve a successful result.

What about an all-on-four concept?

This concept was first introduced in 1998. It has since radically changed the way to replace the teeth of an entire jaw. It is a modification of an immediate-loading implant where the patient can get all their teeth in one or both the jaws within 24 hours.

This is achieved by placing four implants in either jaw. Two implants are placed straight in the front region and 2 implants are placed at an angle of 30 to 45 degrees in either side of the back of the jaw.

Placing tilted implants at the back avoids additional surgeries like sinus lift and bone grafting, thereby reducing the overall final cost as well as the complexity of the treatment. Measurements are taken on the same day and the ceramic prosthesis is made, which is then attached to the implant screws.

Drawbacks of immediate-loading implants compared to delayed-loading implants

Initial stability of the implant and controlled chewing forces are a must for the success of immediate-loading implants. In case there is heavy force on the new tooth in the initial days, chances are that the implant might fail and have to be removed. In certain cases, as the gum heals at the surgery site, there are changes in the anatomy of gums, and the crown may need to be replaced to conform to the new gum shape.

Conclusion

Conventional implants that are loaded after the implant has integrated into the bone give optimum results in terms of longevity of the prosthesis. It is a more prudent approach taken in situations where initial stability cannot be achieved, additional grafting procedures may need to be carried out, or the quality of the bone is questionable.

The immediate-loading approach to dental implants is a big improvement in terms of patient experience and convenience. It does, however, require more precision and experience to pull off successfully. Case selection becomes paramount.

The judgment of the surgeon is what the patients should eventually rely on, although there is no harm in asking about both approaches during treatment planning.