IMMEDIATE LOAD
Immediate load implantology - Italian School Implantology. The expression Immediate Load designates the therapeutic principle of subjecting to functional loads at the end of the surgery an implant just placed in the bone, starting from the end of the surgery, to obtain a better response and a physiological healing pattern. This expression presumably was born at the end of the ’60, when immediate load implantology acquired its own stature as a consolidated therapy, thanks to the ingenuity of Italian implantologists who anticipated of forty years the scientific “discoveries” of this last decade.
Numerous advantages of immediate load implants
The notion of immediate load implants is taking hold more and more in the dental field, and is becoming broadly accepted by the scientific community. What is it exactly?
“The methodology of immediate load is based on special implants, designed specifically to support fixed (temporary) prosthesis, immediately after their placement” explains Dr. Silvano Tramonte, medical director of the Tramonte implantology Centers in Stezzano (BG) and Milan (www.tramonte.com) and teacher of the Electrowelded Implantology course at the Department of Odontostomatology of the Chieti University, headed by Prof. Fanali: “In other words, a patient who has to undergo one or more tooth extractions, or needs a permanent prosthesis, can exit from a single dental session with temporary fixed teeth, provided that immediate load implants are utilized.” What is the difference between traditional implants and immediate load implants? “Traditional implants, also called ‘buried’, or ‘osteointegrated’, remain hidden in the maxillary or mandibular bone for a period between 4 and 6 months. After such period, during which removable temporary prostheses are used, the implantologist has to cut the gum for the second time to fit on the implant the prosthetic part that will support the permanent teeth. On the other hand, in immediate implantology cases no cut is necessary in the gum. A sort of a titanium screw with a post destined to remain out of the gum (immediate load implant) is inserted through a minuscule hole (two mm) to occupy the space where the root of the tooth used to be. A temporary artificial tooth is then applied on the post emerging out of the gum, then a permanent tooth is applied after 30-40 days.”
Oral rehabilitation, or the replacement of teeth lost over the years, sooner or later become necessary for everyone. In three patients out of ten such rehabilitation is convoluted and full of unknown challenges, because the residual bone is atrophic, that is, it presents insufficient size and quality to allow the application of traditional rehabilitation techniques. In the last few years special methods have been perfected to allow these cases of oral rehabilitation to be completed with a minimal amount of surgery. This results in shorter times to complete the procedures dedicated to them. Dr. Tramonte explains: “The method most frequently advised to these patients is maxillary or mandibular bone augmentation, to allow for the application of the most widespread implant techniques, using implants that are large, and present little adaptability. The procedure employed is the so-called autologous bone transplant. This consists of harvesting bone fragments from other parts of the patient’s body (hip or skull) and to transplant them in the areas where bone needs augmentation.” Although very widespread, this solution has drawbacks, complications and contraindications. Also, in a large percentage of cases the bone transplanted in the mandible has a tendency to resorb in part or completely. Tramonte continues: “For patients who do not want or cannot face bone transplants for different reasons (systemic diseases, such as diabetes, heart conditions, hyperlipidemia, etc.) there is an alternative procedure, based on immediate load implant systems, designed to adapt to the little remaining bone. The adoption of titanium immediate load implants, malleable and small, allows them to be anchored in sufficiently solid points even in atrophic bone. This method is not very invasive and has the important advantage of a remarkable shortening of rehabilitation times, thanks to the fact that surgical actions on the mucosa and on the bone (and their healing times) are greatly reduced. One single appointment is sufficient to perform all the operations necessary to clean the mouth (extractions and other hygiene procedures) up to the placement of implants, mostly without cutting the gum. This fist session is completed by placing fixed temporary teeth. This first appointment is followed by two to three months of waiting, after which the remaining procedures are carried out in five different steps: taking impressions, metal tryout, welding tryout, esthetic tryout, assembly of the permanent prostheses in titanium and acrylic, or gold ceramic, or zirconium ceramic.”
The biological saving is remarkable: destruction of the bone tissue is reduced by about 80%. “Being able to heal without attacking and maiming the body is one of the most ancient dreams of man, and this is precisely the objective of bio-implantology. The respectful and minimally invasive approach that is the feature of the Italian School based on immediate load implants has increasing influence on the more widespread Swedish implantology”, stresses Dr. Tramonte. Another formidable instrument made available to us by this fast evolving branch of odontoiatrics is the intraoral welder. “Thanks to it, implant structures can be build inside the mouth” explains Dr. Tramonte. “The fact that immediate load implants have posts protruding from the bone allows to connect them with an intraoral welder, to build a single block that is invisible externally but confers great stability. “The implant absorbs and disperses the immediate load perfectly, even during the healing stages and with insufficient bone.”
In case it is necessary to extract sick teeth, immediate load implants are placed right after their extractions, with any bone reconstructions if necessary. As they are instruments specific to immediate load implantology, these implants allow for temporary teeth to be applied in the same appointment. The patient is not allowed immediately to chew normally, but is not exposed to the embarrassment of showing a defect, especially in the anterior sectors of his/her mouth. There will be chewing limitations for about two months, because implants placed according to the immediate load technique need to wait for the bone to be consolidated. The food allowed will have to be ground, as advised. With this technique patients can have temporary teeth immediately, instead being left with bare gums.”
Apart from having a small surgical footprint, immediate load implants have the other advantage of shortening rehabilitation times considerably. This is because the surgical impacts on mucosa and bone (and consequently their healing times) are reduced. It is possible to extract sick teeth, insert implants and place fixed temporary teeth in the first appointment, then take impressions and arrive to permanent teeth in a few appointments in the course of a couple of months. The time frame necessary for the whole procedure is really reduced. The more advanced immediate load implantology currently offers also an alternative specifically studied for patients lacking sufficient bone: “Thanks to a latest generation technique, the patient can receive the placement of special immediate load implants, with no need to harvest bone”, explains the expert. How is this possible? “The critical anatomical features are circumvented by using small, easily bendable screws, with very angled placements, that exploits in the best possible way any anchorage points even in greatly atrophic mandibles,” explains the implantologist.
In these last few years specific techniques have been perfected to allow persons with a reduced bone crest to benefit from oral rehabilitation with a minimal surgical impact and in a short time. A valid alternative is based on the Italian School immediate load implant systems, that can be adapted to the existing bone almost in every case. The use of immediate load implants, made of grade 2 titanium, that allows the building of sufficiently solid anchorage points exploiting even atrophic bone, is perfectly adapted to existing conditions.
Immediate load implantology - Italian School Implantology. The expression Immediate Load designates the therapeutic principle of subjecting to functional loads at the end of the surgery an implant just placed in the bone, starting from the end of the surgery, to obtain a better response and a physiological healing pattern. This expression presumably was born at the end of the ’60, when immediate load implantology acquired its own stature as a consolidated therapy, thanks to the ingenuity of Italian implantologists who anticipated of forty years the scientific “discoveries” of this last decade.
Numerous advantages of immediate load implants
The notion of immediate load implants is taking hold more and more in the dental field, and is becoming broadly accepted by the scientific community. What is it exactly?
“The methodology of immediate load is based on special implants, designed specifically to support fixed (temporary) prosthesis, immediately after their placement” explains Dr. Silvano Tramonte, medical director of the Tramonte implantology Centers in Stezzano (BG) and Milan (www.tramonte.com) and teacher of the Electrowelded Implantology course at the Department of Odontostomatology of the Chieti University, headed by Prof. Fanali: “In other words, a patient who has to undergo one or more tooth extractions, or needs a permanent prosthesis, can exit from a single dental session with temporary fixed teeth, provided that immediate load implants are utilized.” What is the difference between traditional implants and immediate load implants? “Traditional implants, also called ‘buried’, or ‘osteointegrated’, remain hidden in the maxillary or mandibular bone for a period between 4 and 6 months. After such period, during which removable temporary prostheses are used, the implantologist has to cut the gum for the second time to fit on the implant the prosthetic part that will support the permanent teeth. On the other hand, in immediate implantology cases no cut is necessary in the gum. A sort of a titanium screw with a post destined to remain out of the gum (immediate load implant) is inserted through a minuscule hole (two mm) to occupy the space where the root of the tooth used to be. A temporary artificial tooth is then applied on the post emerging out of the gum, then a permanent tooth is applied after 30-40 days.”
Oral rehabilitation, or the replacement of teeth lost over the years, sooner or later become necessary for everyone. In three patients out of ten such rehabilitation is convoluted and full of unknown challenges, because the residual bone is atrophic, that is, it presents insufficient size and quality to allow the application of traditional rehabilitation techniques. In the last few years special methods have been perfected to allow these cases of oral rehabilitation to be completed with a minimal amount of surgery. This results in shorter times to complete the procedures dedicated to them. Dr. Tramonte explains: “The method most frequently advised to these patients is maxillary or mandibular bone augmentation, to allow for the application of the most widespread implant techniques, using implants that are large, and present little adaptability. The procedure employed is the so-called autologous bone transplant. This consists of harvesting bone fragments from other parts of the patient’s body (hip or skull) and to transplant them in the areas where bone needs augmentation.” Although very widespread, this solution has drawbacks, complications and contraindications. Also, in a large percentage of cases the bone transplanted in the mandible has a tendency to resorb in part or completely. Tramonte continues: “For patients who do not want or cannot face bone transplants for different reasons (systemic diseases, such as diabetes, heart conditions, hyperlipidemia, etc.) there is an alternative procedure, based on immediate load implant systems, designed to adapt to the little remaining bone. The adoption of titanium immediate load implants, malleable and small, allows them to be anchored in sufficiently solid points even in atrophic bone. This method is not very invasive and has the important advantage of a remarkable shortening of rehabilitation times, thanks to the fact that surgical actions on the mucosa and on the bone (and their healing times) are greatly reduced. One single appointment is sufficient to perform all the operations necessary to clean the mouth (extractions and other hygiene procedures) up to the placement of implants, mostly without cutting the gum. This fist session is completed by placing fixed temporary teeth. This first appointment is followed by two to three months of waiting, after which the remaining procedures are carried out in five different steps: taking impressions, metal tryout, welding tryout, esthetic tryout, assembly of the permanent prostheses in titanium and acrylic, or gold ceramic, or zirconium ceramic.”
The biological saving is remarkable: destruction of the bone tissue is reduced by about 80%. “Being able to heal without attacking and maiming the body is one of the most ancient dreams of man, and this is precisely the objective of bio-implantology. The respectful and minimally invasive approach that is the feature of the Italian School based on immediate load implants has increasing influence on the more widespread Swedish implantology”, stresses Dr. Tramonte. Another formidable instrument made available to us by this fast evolving branch of odontoiatrics is the intraoral welder. “Thanks to it, implant structures can be build inside the mouth” explains Dr. Tramonte. “The fact that immediate load implants have posts protruding from the bone allows to connect them with an intraoral welder, to build a single block that is invisible externally but confers great stability. “The implant absorbs and disperses the immediate load perfectly, even during the healing stages and with insufficient bone.”
In case it is necessary to extract sick teeth, immediate load implants are placed right after their extractions, with any bone reconstructions if necessary. As they are instruments specific to immediate load implantology, these implants allow for temporary teeth to be applied in the same appointment. The patient is not allowed immediately to chew normally, but is not exposed to the embarrassment of showing a defect, especially in the anterior sectors of his/her mouth. There will be chewing limitations for about two months, because implants placed according to the immediate load technique need to wait for the bone to be consolidated. The food allowed will have to be ground, as advised. With this technique patients can have temporary teeth immediately, instead being left with bare gums.”
Apart from having a small surgical footprint, immediate load implants have the other advantage of shortening rehabilitation times considerably. This is because the surgical impacts on mucosa and bone (and consequently their healing times) are reduced. It is possible to extract sick teeth, insert implants and place fixed temporary teeth in the first appointment, then take impressions and arrive to permanent teeth in a few appointments in the course of a couple of months. The time frame necessary for the whole procedure is really reduced. The more advanced immediate load implantology currently offers also an alternative specifically studied for patients lacking sufficient bone: “Thanks to a latest generation technique, the patient can receive the placement of special immediate load implants, with no need to harvest bone”, explains the expert. How is this possible? “The critical anatomical features are circumvented by using small, easily bendable screws, with very angled placements, that exploits in the best possible way any anchorage points even in greatly atrophic mandibles,” explains the implantologist.
In these last few years specific techniques have been perfected to allow persons with a reduced bone crest to benefit from oral rehabilitation with a minimal surgical impact and in a short time. A valid alternative is based on the Italian School immediate load implant systems, that can be adapted to the existing bone almost in every case. The use of immediate load implants, made of grade 2 titanium, that allows the building of sufficiently solid anchorage points exploiting even atrophic bone, is perfectly adapted to existing conditions.
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