Workshop Guidelines on Immediate Loading in Implant Dentistry

P redictable formation of a direct bone-toimplant interface is a treatment goal in implant dentistry. The 2-stage surgical protocol established by Branemark et al to accomplish osseointegration consisted of several prerequisites, including (1) countersinking the implant below the crestal bone, (2) obtaining and maintaining a soft-tissue covering over the implant for 3 to 6 months, and (3) maintaining a minimally loaded implant environment for 3 to 6 months. The primary reasons cited for the submerged, countersunk, surgical approach to implant placement were (1) to reduce and minimize the risk of bacterial infection, (2) to prevent apical migration of the oral epithelium along the body of the implant, and (3) to minimize the risk of early implant loading during bone remodeling. After this procedure, a second-stage surgery was necessary to uncover these implants and place a prosthetic abutment. Predictable, long-term, clinical rigid fixation has been reported after this protocol in patients who were either completely or partially edentulous. During the past 15 years, several authors have reported that root-form implants may osseointegrate, even though the implants extend above the bone and through the soft tissues during early bone remodeling. This surgical approach has been called a 1-stage or nonsubmerged implant procedure because it eliminates the second-stage implant uncovery surgery. As a result, the discomfort, inconvenience, and appointments of the surgery and suture removal are eliminated. In addition, the soft tissue is more mature before fabricating a final prosthesis.