The document describes a procedure for immediately loading dental implants with a fixed provisional denture. Key steps include: 1) Extracting hopeless teeth, leveling the bone, and immediately placing and loading implants with abutments during surgery. 2) Taking impressions of the implant abutments and modifying a duplicate denture to fit over them. 3) Delivering a fixed provisional denture within 24-48 hours to eliminate removable provisionals and reduce costs and time. 4) Following up within a week and 2-3 months to adjust occlusion and fabricate a definitive restoration. Immediate loading aims to save time and minimize discomfort compared to traditional approaches.

1. TEETH IN A DAY
Immediately loaded implant supported fixed
provisional denture
Ting-Wey Yen, DDS, MS
4300 Long Beach Blvd Ste 320
Long Beach, CA 90807
www.drdreamsmile.com

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Immediate Loading
 Balshi TJ, Wolfinger GJ. Immediate loading of
Branemark implants in edentulous mandibles: a
preliminary report. Implant Dent. 1997
Summer;6(2):838.
 Schnitman PA, Wohrle PS, Rubenstein JE, DaSilva
JD, Wang NH. Ten-year results for Branemark
implants immediately loaded with fixed prostheses at
implant placement. Int J Oral Maxillofac Implants. 1997
Jul-Aug;12(4):495-503.
 Tarnow DP, Emtiaz S, Classi A. Immediate loading of
threaded implants at stage 1 surgery in edentulous
arches: ten consecutive case reports with 1- to 5-year
data. Int J Oral Maxillofac Implants. 1997 May-
Jun;12(3):319-24.
 Cooper LF, Rahman A, Moriarty J, Chaffee N, Sacco
D. Immediate mandibular rehabilitation with
endosseous implants: simultaneous extraction, implant
placement, and loading. Int J Oral Maxillofac Implants.
2002 Jul-Aug;17(4):517-25.

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Advantages
 Time
 Minimal overall discomfort
 Eliminate removable provisionals
 Cost
 Use existing impression/denture
repair techniques—minimal new
instrumentation

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Disadvantages
 Learning curve
 Lab support
 Requires coordinated visits
between two offices

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PROCEDURE (before
surgery)
 Develop Tx plan with surgeon—
make sure bone adequate
 Establish OVD
 Duplicate lower prosthesis or
 Fabricate new prosthesis
 Fabricate surgical guide
 Modify existing tx denture (24 hr
prior)

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PROCEDURE (day of
surgery)—Surgeon:
 Extraction of hopeless teeth
 Alveolectomy (to level the bone
and create restorative space)
 Place implants
 Place abutments
 Place closed tray impression
copings
 Close up soft tissue--place sutures
 Call Dr. Yen 30 min prior to end

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PROCEDURE (day of
surgery)—Restorative:
 Verify tightness of closed tray
impression copings
 Try in modified tx denture—adjust
as necessary for clearance
 Full arch PVS impression—capture
pear shaped pads
 CJR using the tx denture or
surgical guide

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LABWORK
 Pour up impression
 Mount using tx denture
 Place metal temporary cylinders
 Modify denture to fit
 Check occlusion, connect
 Reinforce with Ribbond
 Fill in the remainder with resin
 Check embrasure, polish

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DELIVERY (24-48 hr):
 Remove closed tray impression
copings—return to OS
 Deliver fixed implant provisional
 Adjust occlusion
 Check embrasures
 Seal with cotton/Fermit
 POD instructions

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FOLLOW-UP
 One week check
 Adjust occlusion -- avoid breakage
 Check embrasure
 OHI: initially-- rinse only; after 3
weeks-start brushing, implant floss
 Fabricate definitive restoration in 2-
3 months

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Precautions
 Keep maximum interocclusal
space
 Alveolectomy to lower ridge height
 Use shortest abutment heights
 Fixture level impressions if
necessary
 Avoid high water design

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After 3
months—
start
fabrication
of final
prosthesis

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Immediately loaded
implant supported fixed
provisional denture
 Time
 Eliminate removable provisionals
 Cost
 Use existing impression/denture
repair techniques—less inventory
 Chee W, Jivraj S. Efficiency of immediately
loaded mandibular full-arch implant restorations.
Clin Implant Dent Relat Res. 2003;5(1):52-6.

42. Thank you
Questions?

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