Dear Dr. Hahn,
I saw your recent webinar about immediate implants and would like your advice. After placing the implant, how do I determine clinically whether there is adequate stability to go ahead and immediately load?
San Jose, California
Obtaining adequate primary stability to support immediate loading depends on a number of factors. First, there must be sufficient quantity and quality of bone to support the implant. With immediate placement, it is paramount to extract the tooth in an atraumatic manner in order to maintain as much bone volume as possible.
Implant selection is another important factor. Tapered implants are more stable at the time of placement than parallel-walled implants. In addition to the tapered design, the Hahn™ Tapered Implant (Glidewell Direct; Irvine, Calif.), which I designed with the team of engineers at Glidewell, has an aggressive thread pattern. The pitch of the threads is designed to help resist vertical forces in immediate loading.
It’s very important to prepare the site so that when the implant is placed, it does not contact the thin facial walls of the socket. For immediate extraction replacements, choose an implant diameter that will be 1 mm to 2 mm away from the facial plate. I set the insertion torque on my drilling console at 40 Ncm. As the implant is being inserted, I guide it firmly against the palatal wall. After placing the implant with the handpiece, I finish with the torque wrench, making sure not to exceed 50 Ncm. If a minimum of 40 Ncm has been achieved, a temporary abutment can be placed along with a provisional restoration. It’s very important that the provisional is completely out of occlusion in all excursions.
Immediate implant placements and loading have been successfully done by many clinicians for more than 40 years. There are many published studies on this topic, with success rates of over 95%. Like all procedures in dentistry, to achieve success we must follow the proven principles.
Jack A. Hahn, DDS