Loading Protocols for Single Implants in Partially Edentulous Patients

Focused Question

Does immediate loading of single implant crowns render different results from early and conventional loading with respect to implant survival rate, marginal bone loss, stability of peri-implant soft tissue, esthetics,and patient satisfaction?

Consensus Statements

• In general, there is a high level of comparative evidence supporting the use of both immediate and conventional loading of single implant crowns in terms of implant survival and marginal bone level stability.
• A minimal insertion torque in the range of 20 to 45 Ncm, a minimal implant stability quotient (ISQ) in the range of 60 to 65, and the need for simultaneous bone augmentation were the most common inclusion/exclusion criteria.
• There are limited data comparing immediate and conventional loading in terms of stability of the papilla height and of the facial mucosal margin.
• Esthetics and patient satisfaction were measured only in a few trials that compared immediate and conventional loading, rendering insufficient data to draw conclusions.

The recommendations for immediate and early loading of single implant crowns are limited to situations fulfilling the following prerequisites:

• Primary implant stability (insertion torque ≥ 20 to 45 Ncm and/or implant stability quotient (ISQ) ≥ 60 to 65
• Absence of systemic or local contraindications (eg, parafunctional activities, large bone defects, need for sinus floor elevation)
• When the clinical benefits exceed the risks

For the anterior and premolar regions, immediate and early loading of single-implant crowns are predictable procedures in terms of implant survival and stability of the marginal bone. However, data regarding soft tissue aspects are not conclusive enough to recommend immediate or early loading of single implant crowns in esthetically demanding sites as a routine procedure. Immediate loading in such sites should be approached with caution and by experienced clinicians.

For the mandibular molar region, immediate and early loading of single-implant crowns is a predictable procedure and can generally be recommended in cases where clinical benefits are identified.

The low amount of data on immediate and early loading of single-implant crowns in the maxillary molar region does not allow general recommendation of these loading procedures. In these sites, conventional loading should be the procedure of choice.