Years ago, immediate load full arch restorations were highly controversial – today, they are the standard. Over the years, evidence (1) has continued to support immediate load methods being safe and effective.
Now, a new controversial approach to full arch restorations has emerged and is drastically changing the experience for both dental providers and patients themselves.
Immediate Load Dental Implants
The process of placing dental implants and attaching a set of fake teeth immediately after is known as “immediate load”. This is commonly done with a “conversion denture”, or set of temporary teeth.
Although this method is widely used by full mouth restoration providers, it often comes with challenges and risks due to the temporary material and non-custom fit of the false teeth. However, the new approach to dental implants that’s causing a stir in the dental community also solves these long-standing problems.
The New Method
Rather than loading newly placed dental implants with a temporary prosthesis (typically made from acrylic plastics) with microflexure, dental professionals are able to immediately load dental implants with a durable set of zirconia teeth.
These zirconia teeth are termed the “final prosthesis” and provide a rigid split for a patient’s dental implants to heal with.
Prosthodontist Dr. Paola Annoni Patel explains how the prosthetic aids in osseointegration, “What do you think the best way for those implants to integrate is? With a set of teeth hanging on them that has some micro flexure to it? Or with a rigid splint that’s going to keep those implants perfectly in place and still so that [the] body can create new bone?”.
Biomechanical research suggests that implant micromotion exceeding 50-150µm during the healing phase can lead to fibrous encapsulation instead of osseointegration (6). By using a rigid zirconia prosthesis as a splint, this method may mitigate micromotion, fostering optimal conditions for integration and stability.
Although this method has sparked controversy in the field of dental implantology, one company implementing this practice has proven to have a 99.13% success rate (8) during the years of 2022-2024. This exceeds the already high success rate of immediate loading with a provisional prosthesis measured in other large studies of 93.3%-98% (2-5).
How is This Done?
Unfortunately, despite it seeming that immediately providing a permanent set of teeth to patients is extremely successful, it is not so easily done.
The ability to fabricate a custom zirconia prosthesis within a reasonable period requires advanced digital workflows, including intraoral scanning, CAD/CAM processing, and sintering technology. Clinics implementing this method must integrate high-throughput milling systems and trained technicians to meet patient needs without compromising precision.
Misalignment could be catastrophic when paired with rigid splinting as studies indicate that excessive stress can lead to marginal bone loss (7).
Dental implant providers must have the technology and bandwidth to custom create the zirconia teeth relatively quickly. The final prosthesis must be created after the dental implants are placed but within a reasonable time frame for a patient to go without teeth if the final teeth are intended to be a rigid splint during the healing period.
Why Offer Permanent Teeth the Next Day?
Providers are incentivized to offer immediate loading of final teeth for a couple of reasons. 1. It creates an exceptional environment for healing and 2. It drastically changes the patient experience.
Immediate loading of a temporary, acrylic prosthesis (otherwise known as a conversion denture) involves an increased potential for breakages, more frequent return appointments, and what can turn into a less than ideal patient experience.
Not to mention, a set of temporary teeth breaking on a patient during the early stages can disrupt dental implant healing.
Although full mouth dental implants can be life-changing for patients with missing or failing teeth, the process to get them can often feel like too large of a hurdle, keeping patients from taking steps forward. That does not have to be the case anymore with breakthrough technology and streamlined workflows as described above.
Just as the immediate load method polarized dental professionals in the past before proving to be superior to traditional methods, immediate loading with a final prosthesis shows promising potential of doing the same.
Sources:
- “Complete-arch fixed reconstruction by means of guided surgery and immediate loading” https://pubmed.ncbi.nlm.nih.gov/31948414/
- “Factors Affecting the Survival Rate of Dental Implants: A Retrospective Study” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774056/
- “The survival rates and risk factors of implants in the early stage: a retrospective study” https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-021-01651-8
- “Long-term implant success at the Academy for Oral Implantology: 8-year follow-up and risk factor analysis” https://jpis.org/DOIx.php?id=10.5051/jpis.2014.44.3.102
- “Long-Term Evaluation of ANKYLOS® Dental Implants, Part I: 20-Year Life Table Analysis of a Longitudinal Study of More Than 12,500 Implants” https://onlinelibrary.wiley.com/doi/10.1111/cid.12154
- “Considerations preliminary to the application of early and immediate loading protocols in dental implantology” https://pubmed.ncbi.nlm.nih.gov/11168189/
- “Timing of loading and effect of micromotion on bone-dental implant interface: review of experimental literature” https://pubmed.ncbi.nlm.nih.gov/9619438/
- https://www.nuviasmiles.com
About the Author
Lucy Steckler has spent the past year and a half deeply immersed in the dental implant industry, documenting the stories of patients and providers alike. After witnessing firsthand the life-changing impact of full mouth dental implants, she remains a passionate advocate—helping others discover the confidence and freedom that comes with a brand-new smile.