MembershipAcademy Events ScholarshipsResearch Tools About Login Join us
Home Academy Consensus Database Consensus Statement
Prosthodontics and Implant Dentistry, ITI CC 2018
Implant Placement and Loading
Protocols
German Gallucci, Adam Hamilton, Wenjie Zhou, Daniel Buser, Stephen T Chen
Implant Placement and Loading Protocols
Implant placement protocols were defined as follows:
a. Immediate implant placement: Dental implants are placed in the
socket on the same day as tooth extraction.
b. Early implant placement: Dental implants are placed with soft tissue
healing (4–8 weeks) or with partial bone healing (12–16 weeks) after
tooth extraction.
c. Late implant placement: Dental implants are placed after complete
bone healing, more than 6 months after tooth extraction.
Implant loading protocols were defined as follows:
a. Immediate loading: Dental implants are connected to a prosthesis in
occlusion with the opposing arch within 1 week subsequent to implant
placement.
b. Immediate restoration: Dental implants are connected to a
prosthesis held out of occlusion with the opposing arch within 1 week
subsequent to implant placement.
c. Early loading: Dental implants are connected to the prosthesis
between 1 week and 2 months after implant placement.
d. Conventional loading: Dental implants are allowed a healing period
of more than 2 months after implant placement with no connection of
the prosthesis.
Consensus Statements
Consensus Statement 1: Proposed classification for assessing
implant placement timing and loading combinations allow
comprehensive treatment selection
The newly proposed classification assessing both the timing of implant
placement and loading combinations allows for comprehensive
treatment selection.
Consensus Statement 2: Immediate placement with immediate
loading, and immediate placement with early loading are clinically
documented protocols while immediate placement with
conventional loading is scientifically and clinically valid protocol
a. Type 1A (immediate placement plus immediate restoration/ loading)
is a clinically documented protocol. The survival rate was 98% (median
100, range 87%–100%). b. Type 1B (immediate placement plus early
loading) is a clinically documented protocol. The survival rate was 98%
(median 100, range 93%–100%). c. Type 1C (immediate placement plus
conventional loading) is a scientifically and clinically valid protocol. The
survival rate was 96% (median 99, range 91%–100%).
Consensus Statement 3: Early placement with immediate loading,
and early placement with early loading presents clinically
insufficient documentation while early placement with conventional
loading is scientifically and clinically valid protocol
Type 2-3A (early placement plus immediate restoration/loading)
presents clinically insufficient documentation. b. Type 2-3B (early
placement plus early loading) presents clinically insufficient
documentation. c. Type 2-3C (early placement plus conventional
loading) is a scientifically and clinically valid protocol. The survival rate
was 96% (median 96, range 91%–100%).
Consensus Statement 4: Late placement with immediate loading is
clinically documented protocol while late placement with early
loading and late placement with conventional loading are both
scientifically and clinically valid protocols.
Type 4A (late placement plus immediate restoration/loading) is a
clinically documented protocol. The survival rate was 98% (median 99,
range 83%–100%). b. Type 4B (late placement plus early loading) is a
scientifically and clinically valid protocol. The survival rate was 98%
(median 99, range 97%–100%). c. Type 4C (late placement plus
conventional loading) is a scientifically and clinically valid protocol. The
survival rate was 98% (median 100, range 95%–100%).
Consensus Statement 5: When considering placement and loading
protocols, multiple factors can affect intended treatment outcome
When considering placement/loading protocols, there are factors that
can prevent the accomplishing of the intended treatment. These factors
include: a. Patient-related factors. b. Lack of primary stability. c. The
need for bone augmentation.
Clinical Recommendations
1) Implant placement and loading protocol should be planned prior
to tooth extraction
Treatment planning for implant therapy should commence once the
indication for tooth extraction has been confirmed. Both the implant
placement and loading protocol should be planned prior to tooth
extraction. The selection of the implant placement and
restoration/loading protocol should be based on achieving predictable
outcomes: a. Long-term hard and soft tissue stability. b. Optimal
aesthetics. c. Reduced risk for complications. d. Meet patient-specific
and site-related criteria.
2) Alternative treatment modalities should be in place as part of the
planning and consent process
As part of the planning and consent process, alternative treatment
modalities should be in place, in the event that specific intra-operative
procedural criteria are not met. Implant placement and
restoration/loading protocols present with different levels of clinical
difficulty and overall treatment risk. When selecting treatment
modalities, clinician skill and experience should match the challenges
associated with the selected protocol.
3) Patient-centered benefits of the different implant placement,
loading protocols and associated risks should be considered
The implant placement and loading protocol can have a negative impact
on survival and success of specific selection criteria are not met, and/or
execution of the clinical procedure is of insufficient quality. Careful
consideration of patient-centered benefits of the different implant
placement and loading protocols and the associated risks should be
taken into consideration.
4) Type 1A protocol should only be considered when there are
patient-centered advantages
Immediate placement and immediate restoration/loading (type 1A) is a
complex surgical and prosthodontic procedure and should only be
performed by clinicians with a high level of clinical skill and experience.
Type 1A protocol should only be considered when there are patient-
centered advantages (e.g., aesthetic requirements, reduced morbidity),
and when the following clinical conditions are met: a. Intact socket
walls. b. Facial bone wall at least 1 mm in thickness. c. Thick soft tissue.
d. No acute infection at the site. e. The availability of bone apical and
lingual to the socket to provide primary stability. f. Insertion torque 25–
40 Ncm and/or ISQ value >70. g. An occlusal scheme which allows for
protection of the provisional restoration during function. h. Patient
compliance.
5) Conventional loading is well documented and recommended with
early implant placement
Early implant placement may be considered in most clinical situations,
such as sites with thin facial walls and defects, often requiring
simultaneous bone augmentation procedures. Conventional loading
(type 2-3C) is well documented and is recommended with early implant
placement. Immediate (type 2-3A) and early (type 2-3B) loading
protocols combined with early implant placement are not sufficiently
well documented to be recommended as routine procedures.
6) Late implant placement is the least desirable option due to the
risk of alveolar ridge resorption
As a planned procedure, late implant placement is the least desirable of
the placement time options, due to the risk of alveolar ridge resorption
and reduction in bone volume, as well as extended treatment time.
When late placement is indication for patient- or site-related reasons, an
alveolar ridge preservation procedure is recommended.
7) Early loading and conventional loading are well-documented
protocols for late implant placement
In the case of late implant placement, early loading (type 4B) and
conventional loading (type 4C) are well-documented protocols and may
be considered routine. Late implant placement with immediate loading
(type 4A) may be considered when patient-centered advantages are
present, and the criteria for immediate restoration/loading are met.
Downloads and References
Implant placement and loading protocols in partially edentulous
patients: A systematic review
Bookmark item
6th ITI Consensus Conference Consensus Statement English Languages
Prosthodontic Planning & Procedures
Related content
Prosthodontic Planning and Pro… Prosthodontic Planning and Pro… Prosthodontic Planning and Pro…
Accuracy of Different Number of Implants Immediate Loading
Dental Impression Placed for Complete- vs.
Techniques for Arch Fixed Prostheses Early/Conventional
Implant-Supported Loading of
Dental Prostheses Immediately Placed
Implants in Partially
Consensus Statement Consensus Statement Edentulous
Consensus Patients
Statement
from the Patients’
Share this page
Download the QR code with a link to this page and use it
in your presentations or share it on social media.
Download QR code
Community Education Online Resources Organization
Fellows & Members Curriculum
Learning SAC Assessment Tool Who We Are
Study Clubs Education Weeks Assessments Consensus Database Sections
Events Publications Learning Pathways Press Releases ITI Headquarters
Discussion Forums Scholarships Theory & Principles Videos Our Partners
Clinical Applications
95,000+ Professionals in implant dentistry
Join our community now
Contact Imprint Articles of the ITI Terms & Conditions Privacy Policy Terms of Use © ITI International Team for
Cookie Preferences Implantology 2023
