Immediate Dental Implants…Things To Consider

“Immediate loading” is a hot topic in implant dentistry.

In its most basic definition, it means you will have a tooth on your dental implant within 24 -48 hours of surgery.

Here is an example of the entire lower jaw replaced with nine implants and an immediate bridge:

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Every patient that I have treated has always wanted his or her teeth right away. You really should weigh the risks versus benefits of this procedure.

Immediate teeth work best for teeth in the front of the mouth.  It also works very well if you are missing all your teeth and is most successful if you are having implants for your whole lower or upper jaw.  The use of zygomatic implants also allows for same-day teeth in people that are missing all upper teeth even when they have soft bone.  When the dental implants are put in, I would make a temporary tooth or whole set of teeth right on the spot.  You would walk out of my office with teeth not gaps. The temporary teeth will look, feel and work like your regular teeth.

You have a big role in the success of this awesome procedure.  I will tell you, that you have to be committed to a soft diet for about 3 -6 months. Even though a tooth is made on the immediate, same day implant, it still has to fuse to your bone. This is called “osseointegration.”  If you can’t commit yourself to this, immediate loading or immediate temporaries are not for you. It has a high risk of failure if you chew harder foods too early. All of the implants can fail.

If it were just one tooth, like your front and center upper tooth, I would make the immediate temporary so it doesn’t touch the bottom teeth. This further prevents the chance of using the tooth too early.

Some of the important factors in determining if immediate loading can be done are:

  • Bone density
  • Amount of bone
  • Initial stability of the implants
  • Shape and type of gum
  • Implant design and type
  • Your bite

What’s the race to get a tooth today? I am all for immediate dental implants when it does not pose a significant risk of failure to you.  Meaning if it is just as successful to have the immediate implant, as it is the traditional “delayed” approach, then you should strongly consider it. It may even reduce the total cost, too and saves time.

I have a lot of experience in this and let me tell you this is not for the novice implant dentist. One tiny error can yield disastrous results.

The next level up is an immediate implant with a temporary on the same day the tooth is extracted! This is a very common procedure I perform in my office in Burbank, California for the last 18 years.  I most commonly do this for front or side teeth.  If there is infection, it may not be an option for you.  Sometimes the infection dissolves the really thin bone on the outside surface. If this is the case, an immediate dental implant is not recommended.

Here is an example case of a front tooth immediate dental implant. 

A bone graft is sometimes necessary with immediate load dental implants and can be done at the same appointment. Every situation is so different.

With any situation you should have a back up plan.  In my opinion, this procedure is a bit “over-marketed” as a solution for everyone, but it really only accounts for about 5-15% of situations.  There are times that immediate implants are planned, but during the surgery I find that the bone or implant is not strong enough and I have to abort and not put the implants in that day.

I always have a back up temporary tooth ready just in case!

Bottom line…. immediate dental implants are great in the perfect situation. Pre-surgical planning and expert execution of the procedure makes all the difference.

Please feel free to ask questions and comment below!


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16 thoughts on “Immediate Dental Implants…Things To Consider

  1. Courtney Adrian

    Hello, my son’s head collided with my front tooth about a week and a half ago and it’s starting to die by the way it’s changing color. I went for impressions today, and I’m going to get it pulled tomorrow with a temporary flipper. I’m only 28 years old and the last thing I want is invisible fake front tooth. I am wondering if it’s possible to get an implant same day, if the tooth has been pulled and healed for however how many months before I could afford an implant. I’m in Canada, and have been looking in the South for Implant options, as it is more affordable. I also do have bone loss, so I don’t know what my options are but I do want something that is more permanent and most natural-looking, do you know what options I have? Thank you in advance

    Reply
    1. RamseyAminDDS Post author

      I hope you had a really good socket preservation bone graft. At age 28, I try to do everything possible to put the implant at the same time the tooth is removed. This can become very costly if you have to rebuild the bone rather than preserve what you have already. I’m hoping and praying that you had the implant put in to avoid costly bone grafting such as a bone block graft.

      Reply
  2. M. Z.A

    I want to know lateral stability of screw inserted inside bone. What is the diameter of screw as a minimum to be used for single implant. How much length of screw will be be inseted inside bone.

    Reply
  3. Dave Hill

    ? I plan on having 6 implants in my upper law. I am a new denture wearer (2 months now) and am waiting for the end of the 2 mon. to start the implant pro. Can I use 2 immediate load implants and mod. the full upper to hold without the glue while the other 4 are healing? Then once the other 4 have secured themselves I can add the 4 add. posts and have a new upper made holding on with the 6 studs. I am thinking about the ZEST large stud sys. (can’t remember the name of the new coated ones right now but those are what I am considering. ) This will be a removable over-denture.

    Reply
  4. Gary Tikriti

    Hi Dr. Amin,
    I really like your article and I would like you to clear something.

    I broke my tooth (#8) in the front upper jaw and had it bone grafted last
    November 5th. My dentist told me that I have to wait 3 to 6 months before he can
    place the implant and abutment installed and about 4 months to place the crown,
    I’m currently in the first waiting period. Do I understand it right that the
    second waiting period (4 months) can be avoided i.e. the implant, abutment and
    crown can be done at the same time? or at least shorter time period! If not,
    what is the shortest time needed between the implant and the crown? I would
    appreciate some more information regarding this with an approximate cost
    involved.
    In addition, which system is used in “Immediate Loading” (a titanium dental implant with titanium abutment, a titanium dental implant with a zirconia abutment or all white zirconia implant one-piece), and what ‘s the cost involved? I shall be looking forward to hear from you. Thank you,

    – See more at: http://www.burbankdentalimplants.com/zirconia-dental-implants-pros-and-cons-video/#sthash.O7efvUUJ.dpuf the Immediate Loading?

    Reply
    1. RamseyAminDDS Post author

      unfortunately I cannot answer your questions with regards cost. The upper front teeth are very complicated. Going slow is almost always better than going fast. Although immediate dental implant preserve the existing gum shape and bone, there can be disastrous results if things are moved to quickly. Is to qualify for any immediate implant, the implant itself must engage the bone about 30-40% longer than your existing root. Just because you have any immediate implants put in the same day it is extracted that does not mean that you can have an immediate temporary or an immediate tooth on top of it. I know this sounds complicated but a lot of this is determined by bone density and surgical experience. Shortening the waiting period, must be carefully chosen. I would not do an all zirconia abutment but and abutment that had a metal hex interfaced would be just fine. I do not suggest that the implant screw itself be made of zirconia as this is usually one piece and does not do well when the bone trajectory is angulated which often occurs in the upper front teeth.

      Reply
  5. Dr. Ramsey Amin

    Hi June,
    Sorry for the delayed reply. My computer hard drive crashed!
    Unfortunately, each situation is VERY unique. I suggest you get in touch with an expert implant dentist. Use the link in the upper right to find someone who is certified by the American Board of Oral Implantology.
    Do you have any x-rays you can post?

    Reply
  6. June Swinerton

    my endodontist almost refused to tell me what risk were involved in implants. I had front tooth root canal failure (was also crowned) and he immediately suggested implants- i mentioned retreatment- he claimed he had a 80 percent success rate. During the procedure I felt all was good, as soon as he was done he said the tooth was cracked. I heard it crack during the proceedure and it wasn’t on the first x-ray, now I am forced to do an implant and wasted 400 dollars for the attempted retreatment. I am not rich. I did have some bone loss- tooth number 8. I am apprehensive about an implant and got no information of the risk. What options do i have and what is a mini implant. the other front tooth was also crowned so I was wonderting about the bridge option too. I was told to go one type of specialist for the one solution, and another for a bridge- but I cant keep running around spending money (120) each just to talk about information. I found much on the internet and the dentist I have talked to have not supplied me with. I need to make a fully informed decision. Any help (even websites explaining risk) would help. June

    Reply
    1. brett

      hi
      I am considering getting a number 31 tooth extracted and implanted on the same day with pre- loading. is this becoming more of common practice?

      thanks

      Reply
      1. RamseyAminDDS Post author

        please reference the area where your tooth is being removed. Tooth #31 in the American system is very different than tooth #31 in the international dental numbering system. One is a front tooth and one is a back tooth. The answers are completely different depending on the area.

        Immediate molar implants for American tooth #31 are possible using wide body dental implants.

        Reply