Diagnosis and Planning in Immediate Loading: Surgical Diagnosis

For several decades, two-dimensional images were the only available for the surgical diagnosis prior to implant placement. The introduction of digital radiology and software applications for three-dimensional imaging has increased the prospects of success in implant diagnosis and surgical placement. The CBCT is definitely more precise and complete than panoramic radiography, but it is not always mandatory for every case. Success for fixed implant-supported rehabilitations, especially in immediate provisionalization techniques, depends on accurate pre-surgical evaluation of the following issues: (1) recognize feasible restoration procedures to rehabilitate patient edentulism; (2) list all the therapeutic possibilities, even if non-fixed solutions, evaluating the cost/benefit ratio of all treatments; (3) suggest the most correct treatment to the patient, after accurate evaluation of patient’s chief complaints; and (4) diagnosis and treatment proposal should be verified with a team that can supply technical support through knowledge and expertise about surgical, prosthetic, and laboratory requirements. The mechanical behavior of the bone is a determining factor for successful osseointegration. The most popular method for bone quality assessment was suggested by Lekholm and Zarb, and it was a radiographic index. Primary stability is for utmost importance during immediate loading protocols. Several invasive or noninvasive methods are employed to test the implant clinical stability: the Periotest, surgical insertion torque, and resonance frequency analysis are classified among the noninvasive ones. Primary stability is heavily influenced by the surgical technique adopted. An expert surgeon might compensate for limiting factors such as type of jaw or bone quality. The immediate loading is a high-risk treatment, and just skillful surgeons could be able to identify optimal bone conditions under which patients can be treated conventionally.