Feb 22


Patients very frequently ask this question  and the answer is sometimes, and it depends.

With any surgical procedure, many variables need to be taken into account in order to assure success.

When a patient asks this question, I ask the patient “What is it we are trying to accomplish.”  If the desire is to remove a tooth, and immediately load and restore the implant with a crown the same day, chances are slim that this can be accomplished.

If a dental implant is to be placed the same day as an extraction, and left submerged to heal for several months, this can be accomplished very often.

In order for an implant to be loaded and placed into service with a crown, the implant needs to fit tightly with a very specific torque requirement.  Studies have shown the implant needs to have a torque setting of 35-45 Newtons/per meter or 25-35 ft.lbf  in order to support a crown immediately.

This does not mean that a dental implant with a lower torque than this will be unsuccessful or fail.  This implant however needs to “heal” and then be placed into service later in order to be successful.

The initial protocol for dental implants which made them very predictable was to have them all submerged below the gum line for a period of between 3-6 months.

Then some doctors started to load or place crowns on them immediately and found many could still be successful.  It was then found of the successful dental implants that they all met a minimum threshold torque setting, and a minimal bone density measurement.  The bone density measurement is done in Hounsfield units.

This does not quarantee success however, even if it meets the above requirments.  A failure can occur.

I always feel that a patient’s real concern is going without the tooth and having to wear a removable partial to replace the tooth while the implant heals.

Placing a dental implant and loading it the day you extract the tooth may be possible and may work.

However, in one out of ten cases a failure will occur when placed with this immediate protocol and a patient is almost always in a compromised situation afterwards with loss of bone as opposed to if the implant was not loaded and submerged.

This doctor finds it easier to deliver a fixed resin or metal resin wing bridge on adjacent teeth the day of the extraction and implant placement.  These wing bridges (Maryland Bridges) were considered permanent and this doctor will construct them at near cost to the patient when used as a temporary for an implant.

The optimum situation for an immediate extraction, immediate implant placement  and crown placement is a single rooted tooth.  The newly placed implant should be firm, and intimately contacting with the walls of the old extraction socket.  I find the most success where the new implant extends about 1/3 of the length passed the terminal end of the old tooth.

I do inform the patient that an immediate crown on the date of the implant placement can never be guaranteed to be delivered.  If a doctor guarantees he can always put a crown on the implant the date the implant is placed he or she is either ignorant of the required torque and bone density or is ignoring the facts.  This situation of hoping for a very remote chance of things working out is not a way to treat patients particularly since the implant failure will compromise the site for future implants.

Dr. Dibling always gives consults for dental implants at no charge.  Average consult time spent with a patient is usually at least 45 minutes to an hour.  During this time you will be shown photos from start to finish and be educated on all your options inclusive of non-implant choices.

You can see Dr. Dibling’s own patient testimonials on the website.

So, if you are tired of a 5 minute consult after sitting in the patient waiting room for an hour, you are right, you deserve better!  Make a call for an appointment and hear what you have been missing.