General Diagnosis and Medical Evaluation

  • Ugo Covani
  • Paolo Toti
  • David Soto-Peñaloza
  • Enrica Giammarinaro
  • Luis Cuadrado
  • María Peñarrocha-DiagoEmail author


Current literature does not contribute to a high level of evidence regarding possible indications for immediate loading. A great variety of exclusion criteria for immediate loading of dental implants are used in different studies. However, the reported criteria are similar to those chosen for conventional loading of dental implants. Despite its several clinical advantages, the immediate loading protocol should be performed respecting a rigorous preliminary diagnostic algorithm. Primary indication for immediate implant loading is certainly patients’ desire to reduce the overall treatment time. Additionally, several psychological factors, related to the preservation of functional and esthetic outcome, represent solid indications to immediate loading. Patients who are accustomed to edentulism and have been wearing a removable denture for a long time might not perceive any significant discomfort in waiting a few more months to get their final restoration. On the contrary, a recent trauma in the esthetic area or the sudden need for extraction of several compromised teeth presents a challenge to patient acceptance of delayed loading implant therapy. Contraindications to immediate loading could be gathered into local or systemic and into absolute or relative. Among local contraindications, there is the lack of adequate adjacent bone levels. Excessive smoking or para-functional habits (severe bruxism or clenching habits, poor oral hygiene, and local inflammation) could be considered as relative or transient contraindications. Some authors reported successful outcomes also in heavy smokers and bruxers. The immediate loading of implants in such sites without preliminary reconstructive surgery may compromise esthetics and phonetics. Poor density bone is now considered a relative contraindication since it can be addressed with modified implant macrostructure and surgical technique. Immediate loading is not recommended in patients with lack of posterior occlusal support, especially when they plan to rehabilitate the anterior area which would be subjected to unfavorable shearing and non-axial forces.


Immediate loading Diagnosis Bone quality Bruxism Oral hygiene Smoking 



Computer-aided design/Computer-aided manufacturing


Torque insertion Newton’s per centimeter


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ugo Covani
    • 1
  • Paolo Toti
    • 2
  • David Soto-Peñaloza
    • 3
  • Enrica Giammarinaro
    • 2
  • Luis Cuadrado
    • 4
  • María Peñarrocha-Diago
    • 3
    Email author
  1. 1.Department of Surgical, Medical, Molecular and Critical Area PathologyUniversity of PisaPisaItaly
  2. 2.Istituto Stomatologico Toscano, Fondazione per la Ricerca e l’alta Formazione in OdontoiatriaLido di Camaiore – LUItaly
  3. 3.Oral Surgery Unit, Department of Stomatology, Faculty of Medicine and DentistryUniversity of ValenciaValenciaSpain
  4. 4.i2 Implantology-Clinical and Education CentreMadridSpain

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