Immediate load dental implants -
Risks you must know about

Immediate load dental implants are implants that have teeth fixed to them within 48 hours of being inserted. This is different to normal procedure.

Normally, a dental implant is allowed to heal on its own for 3 to 6 months before a tooth is fitted to it.

It is important to understand that immediate load dental implants are exactly the same as any other implants. It is not the implants that are different. What is different is the method and timing of fitting teeth to them.

They are called "immediate load" because the dental implant companies claim that a load can be put on them almost immediately. I have a problem with the term "immediate load" implants".

For two reasons;

First of all, they are not what they claim to be.

Second, this method can only be used in certain very specific situations. I will explain in a minute. But why would anybody ever want "immediate load" implants in the first place?

Because it's a great marketing tool. But unfortunately this is similar to the situation with "one-hour laser tooth whitening". Patients read about these things in glamour magazines that tend to be great at promoting "bleeding edge" medical techniques while keeping quiet about the limitations and disadvantages. The general public is given the impression that any decent dentist can offer these services, and that they always work.

So a huge public demand for these treatments builds up, and dental companies exploit this demand by bringing out products that they market to dentists as being reliable. Again, the specific limitations tend to get brushed under the carpet.

There are lots of advertisements out there now, offering "teeth in one hour", and "All On Four". (Meaning all your new teeth can be supported by just 4 implants.) It gives the impression that you can walk in and get those bad teeth whipped out, and new ones fitted in the twinkling of an eye!

Immediate Load Dental Implants - It ain't that easy!

Why not? Here's the problem. The inventor and developer of modern dental implants, Professor Per-Ingvar Brånemark, laid down the basic rules for implants. Remember, he is an orthopedic surgeon. He knows how bones heal. And he knows how to get the best success rates for dental implants.

A black and white image of Professor Per-Ingvar BrånemarkProf. Brånemark

One of the critical aspects is that the implant should not move AT ALL during healing. It's a bit like a broken leg. If you keep using your broken leg while it is healing, it is unlikely to heal properly, and you end up with fibrous tissue growing in between the broken ends.

You end up with two shorter bits of bone with a wobbly "joint" between them. You cannot use the leg properly. You'll have to get an orthopedic surgeon to re-set the fracture for you.

It's similar with a dental implant. Except that you have a foreign body in there. The dental implant. If the bone doesn't fuse to the implant first time round, it never will. No second chances here. The implant will be loose, prone to infections, and will not take any "load" at all. It will have to be removed.

Prof. Brånemark made it clear that even micro-movement can interfere with the healing process. This means that any tiny movement at all may stop the implant from fusing to the jaw bone.

Doesn't it seem crazy to invite disaster by asking your brand new implants to carry some teeth?

The term "immediate load dental implants" is misleading. The tooth that is fitted to the implant is deliberately trimmed down short so that you cannot actually bite on the tooth. The dentist actually makes sure that you cannot "load" the implant!

So, while it's called an immediate load implant, he's doing his best to make sure it's not! This tooth is really a "long-term temporary" solution, because at some point it will need to be replaced with the final tooth that is the correct shape.

But even fitting a smaller tooth to avoid contact with the other teeth doesn't guarantee success. Your dentist can't control what you eat. You can chew some food and still put some loading through that fresh implant. Remember what Prof. Branemark said? NO movement at all, not even micro movement!

My objection is that the phrase does not mean what it says, and that the technique is risky in the real world because it tends to get used in unsuitable situations.

Is there any time at all when immediate load dental implants can be used? Yes, but in my opinion these times are quite limited. First of all, the implant must be placed into good quality bone that is dense enough, so that the torque required to fit the implant is more than 35NCm.

Ideally, it should be one of the front teeth, with solid teeth on either side. And the "new tooth" must be trimmed to the correct shape so that it cannot be bitten on directly at all.

In what situations should immediate load implants be absolutely avoided? Replacing all the teeth in the upper jaw. The bone of the upper jaw is more porous, and therefore less dense. The success rate for immediate load dental implants in the upper jaw is not good if you attempt to replace all the teeth with a bridge. This will only work reliably in the lower jaw, where the bone is more dense, and where the implants can fitted with a torque greater than 35 NCm.

In the upper jaw, immediate load dental implants should be limited to to single-tooth replacement (in my opinion).

So there you have it. Immediate load dental implants are not really "loaded" after all, but still allow the potential for sideways forces to create micro-movement, which will lead to implant failure. I believe that this technique works best in the lower jaw, and for front teeth only. The ONLY benefit is that you get a fixed tooth quickly, without having to wear a dental flipper (part denture) for 3 months.

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