Three different “immediate” decisions
Patients often hear one word for three separate choices. The timing of placement can be immediate (into the socket on the day of extraction), early (about two months later, once the gum has closed) or late (after six months or more) (Hupp et al., 2014). The timing of loading is a second decision: whether a provisional tooth is attached within the first days, or whether the implant heals untouched. And a third, the type of provisional, determines how much force reaches the implant. Immediate placement with a provisional may preserve the shape of the gum best, but it carries two disadvantages: the implant never matches the shape of the root socket it enters, and a provisional invites biting forces too early (Hupp et al., 2014).
Why immobility is the whole story
Bone bonds to an implant only when the implant does not move. The surgical textbook puts it plainly: with low stability the implant is buried and left alone in two stages; with adequate primary stability it can heal in one stage and “may be loaded immediately” (Hupp et al., 2014). The critical variable is micromovement. Displacement in the range of 50–150 micrometres during healing can lead to fibrous tissue and bone resorption rather than integration (Resnik & Misch, 2018). Everything in the immediate-loading protocol, from the torque threshold to the softened bite on the provisional, exists to keep movement below that range.
How stability is measured in the chair
Two instruments give two different readings. Insertion torque is the resistance the bone offers as the implant is seated; a value of 35 Ncm or more is described as good primary stability, and 32, 35 or 40 Ncm are the thresholds various authors prefer for immediate loading (Hupp et al., 2014; Resnik & Misch, 2018). Resonance frequency analysis attaches a small transducer to the implant and reports an implant stability quotient (ISQ); values of roughly 55–85, with a mean around 70, are cited as acceptable. Torque and ISQ measure different features of stability and are read together, and the literature is candid that no clinical study has established a minimum ISQ for the long-term success of immediately loaded implants, so standardised ranges should not be relied on completely (Resnik & Misch, 2018). In soft bone, under-preparing the site or countersinking can improve initial grip (Resnik & Misch, 2018).
Criteria for immediate placement into a socket
- The tooth is removed without infection and without damage to the socket walls.
- At least 4 mm of firm bone is available beyond the root tip for the implant to anchor in (Hupp et al., 2014).
- In the smile zone, the bone wall on the lip side is intact and at least about 1.5 mm thick; if thinner, a graft and membrane are placed at the same time (Resnik & Misch, 2018).
- If the bone cannot stabilise the implant, immediate placement is not recommended; a delay of about two months allows soft-tissue closure and resolution of any infection (Newman et al., 2019).
A same-visit restoration on an immediate implant is described in the surgical textbook as appropriate only “in isolated cases”, with firm contacts against the neighbouring teeth to limit loading (Hupp et al., 2014).
Who should wait: the delayed-protocol list
We advise a delayed protocol when one or more of the following is present:
- Stability below threshold or very soft (D4) bone, typical of the back of the upper jaw.
- Thin or missing bone wall in front of an upper front tooth; around 20% of immediate anterior implants in the literature showed suboptimal gum appearance from recession, linked to thin tissue, forward tilt and a damaged wall (Resnik & Misch, 2018).
- Heavy clenching or grinding; occlusal overload is the key concern, and failures of immediately loaded implants cluster in weeks 3–5 as mobility without infection (Resnik & Misch, 2018).
- Active infection at the site.
- Smoking or a compromised medical status, as relative factors.
- A large sinus-membrane tear during a simultaneous sinus lift.
- A removable denture resting on the healing site; parafunction on a soft-tissue-borne denture over a healing implant is a common failure cause (Resnik & Misch, 2018).
Delaying costs a few months; loading an unstable implant can cost the implant. In our experience patients accept the wait readily once the reasoning is explained.
What the numbers say
Immediate implants placed according to criteria perform well: a review cited in the complications literature reports an annual failure rate of 0.82% and two-year survival of 98.4% (Resnik & Misch, 2018). Guided surgery combined with immediate loading, however, carried an average complication rate of 42% across six papers, a reminder that stacking techniques multiplies risk (Resnik & Misch, 2018). Over the long term, the classic benchmarks for implants in general are survival in the mid-nineties at ten years (Adell et al., 1981; Albrektsson et al., 1986), and loading protocol is one of several factors, alongside maintenance, that determine whether an individual implant reaches them.
The provisional tooth: rules for the first weeks
An immediately loaded crown or bridge is a provisional kept slightly out of the bite and free of sideways contacts. A soft diet for the healing period, no chewing gum, no biting with the front teeth, and no smoking are the main instructions. Cleaning is gentle brushing from the first day and interdental cleaning once the gum has closed. The definitive crown or bridge follows after osseointegration, generally several months later. For full-arch cases the day-by-day expectations are described on our provisional bridge page.
Visit plan for international patients
- WhatsApp pre-assessment: a panoramic X-ray and photographs indicate whether immediate protocols are plausible; a definitive answer waits for the CBCT.
- Visit 1 (generally 4–7 days): examination, CBCT, extraction and implant surgery, stability measurement, provisional if thresholds are met, bite check and review before departure.
- Healing (generally 3–6 months): remote photo check-ups.
- Visit 2 (generally 5–7 days): impressions and the definitive restoration.
What determines the cost?
- Whether immediate loading is possible and the type of provisional (fixed or removable).
- Socket grafting or membrane for a thin bone wall.
- Implant system, abutment and the definitive crown or bridge material.
- Number of implants and any additional surgery.
A written fee follows the examination and CBCT; our prices and campaigns page explains the fee structure and instalment options.
Searching for the “best same-day implants in Istanbul”: what to check
- Does the clinic measure stability (torque and/or ISQ) and state the threshold it uses?
- Is there a fallback plan if the threshold is not met, and is it explained before surgery?
- Is the same-day tooth clearly described as provisional?
- Are smile-zone cases assessed for bone-wall thickness and gum type on the CBCT?
- Is heavy grinding screened for, and a night guard planned?
- Is follow-up organised for the critical weeks after you return home?
Frequently asked questions
What is the difference between an immediate implant and immediate loading?
An immediate implant is placed into the socket on the day the tooth is removed. Immediate loading means a temporary tooth or bridge is attached to the implant within the first days. The two can be combined, but each has its own criteria and one does not imply the other.
How is primary stability measured?
Two ways: the torque needed to seat the implant, with 32 to 40 Ncm cited as the preferred range for immediate loading, and resonance frequency analysis, which gives an ISQ value of roughly 55 to 85 in acceptable cases. The two measure different aspects of stability and are read together.
Who should not have same-day implant teeth?
Patients whose implants do not reach the stability thresholds, those with very soft bone, an infected socket, a thin or missing bone wall in the smile zone, heavy clenching or grinding, and, as relative factors, smokers and medically compromised patients. For them a delayed protocol is safer.
Can the plan change during surgery?
Yes. The decision to load immediately is made from the stability measured during surgery. If the threshold is not reached, the implant is left to heal and a removable temporary is used instead. We discuss this possibility before surgery.
Is an immediately loaded tooth the final tooth?
No. It is a provisional kept out of heavy biting. The definitive crown or bridge is made after osseointegration, generally several months later.
Does immediate loading increase the risk of failure?
When criteria are met, immediate implants show high short-term survival, around 98% at two years in a review cited in the literature. When failures occur they cluster in weeks three to five and are usually linked to overload, and in the front of the mouth about one in five immediate cases showed some gum recession, so case selection matters more than the technique itself.
Related guides
Contact: Yayla Dental Akademi, Ferit Selimpaşa Cad. No:44A, Bahçelievler, Istanbul (Basın Sitesi, opposite Migros; about 600 m from İlkyuva metro station). Monday–Saturday 10:00–21:00, Sunday closed. WhatsApp and phone: +90 544 289 66 33 · Online booking: DoktorTakvimi.
Sources
- Hupp, J. R., Ellis, E., & Tucker, M. R. (2014). Contemporary oral and maxillofacial surgery (6th ed.). Elsevier Mosby. WorldCat
- Resnik, R. R., & Misch, C. E. (2018). Misch’s avoiding complications in oral implantology. Elsevier. WorldCat
- Newman, M. G., Takei, H. H., Klokkevold, P. R., & Carranza, F. A. (Eds.). (2019). Newman and Carranza’s clinical periodontology (13th ed.). Elsevier. WorldCat
- Albrektsson, T., Zarb, G., Worthington, P., & Eriksson, A. R. (1986). The long-term efficacy of currently used dental implants: A review and proposed criteria of success. International Journal of Oral & Maxillofacial Implants, 1(1), 11–25. PubMed
- Adell, R., Lekholm, U., Rockler, B., & Brånemark, P.-I. (1981). A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. International Journal of Oral Surgery, 10(6), 387–416. PubMed
- Pjetursson, B. E., Thoma, D., Jung, R., Zwahlen, M., & Zembic, A. (2012). A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years. Clinical Oral Implants Research, 23(Suppl. 6), 22–38. PubMed
- Dodson, T. B. (2012). Predictors of dental implant survival. Journal of the Massachusetts Dental Society, 61(3), 20–22. PubMed
Search the databases: PubMed · Google Scholar · NIH PMC · Scopus · Web of Science · Embase (institutional access may be required).
This page is for information only; diagnosis and treatment plans are determined by a dentist after an examination. Survival figures are population averages from the cited sources and do not describe an individual outcome.