Ever since Brånemark introduced his system and the concept of osseointegration back in 1977, and advocated a specific dental implant healing time of 3 months (for implants placed in the mandible) and 6 months (for implants placed in the maxilla) before they can be loaded, it has been recognized as best practice.
In fact, his guidelines were so widely accepted as the “rule of thumb” to ensure optimal healing time — and therefore, increasing the chances of implant success — that dentists all over the world still follow these guidelines, regardless of new published data.
And indeed, over the last few decades, multiple studies have shown that dental implants CAN be successfully loaded on the day of their placement or after healing times of much less than 3-6 months.
So, what happened?
While it is obvious that biology has not changed, two things have: 1) Our understanding of the osseointegration process, and 2) Implant design and surface technology.
- Based on a series of randomized controlled trials carried out over a number of years involving thousands of participants, it is clear that loading implants after a period of 6-8 weeks, or even on the day of their insertion, shows no difference in bone loss, implant failure or prosthesis failure when compared with implants that were loaded following the conventional 3-6 months healing time.
- The development and/or improvement of implant surface technology (including Adin's own OsseoFix surface) which now supports steadier and faster bone integration, suggests that implants with adequate initial stability can be loaded in both jaws within a time frame of 6-8 weeks. This is without jeopardizing success rates.
This combination of a better understanding of the biological processes related to osseointegration of dental implants and technological surface advancements has lead to a paradigm shift in the daily clinical practices that betters the quality of life of patients.
Why change the old ways?
A waiting time of 3-6 months is still valid, but one needs to understand that this is no longer the only option. In fact, adopting the immediate and early loading protocols provides better and a safer treatment options for both dentists and patients.
In addition, patients do not have to suffer bulky and uncomfortable temporary dentures, or compromised function and esthetics, while waiting for the implants to osseointegrate. As such, dentists can gain financially by delivering interim and final restorations after much shorter times.
Dentists may be reluctant to change what is "working fine”, fearing that they are going against the grain when considering loading implants immediately or after a shorter period. Any change may be difficult to adopt, so it is important to note that, based on current literature, loading within 6-8 weeks is the norm rather than the exception.
Furthermore, it is the recommended thing to do in most cases, if one understands the healing process and considers the major influencing factors such as:
- Careful case selection
- Implant's initial stability
- Controlled occlusal forces
- Implants' design and surface
- Patient's oral and overall health condition
So, what is the "take home message"?
Advancement in implant design and surface, coupled with better understanding of the osseointegration process, has led to evidence-based research that supports implant loading immediately or after a period of 6-8 weeks. While this becomes the new "rule of thumb" for implantologists, one must always consider each individual patient and their specific conditions.
Adopting shorter dental implant healing time benefits both patients and dentists, and should be considered in order to ensure successful implant-based treatment.