Immediate loading in the maxillary arch: evidence-based guidelines to improve success rates: a review

The reliability of immediately loaded dental implants in the mandible has prompted many to investigate their application in the maxilla. Although the body of literature is growing, the long-term survivability of immediate loading in the maxilla is still pending. This review of literature investigates the status of immediate loading of dental implants in the maxilla to determine its predictability as a treatment option for partial and complete maxillary edentulism. Current terminology in the field is summarized first. Subsequently, the rationale and advantages of immediate loading in the maxilla are reviewed, and the relationships between immediate loading and osseointegration, primary stability, implant design, micromotion, immediate implant placement, and bone character are explored. The importance of a prosthodontically driven implant treatment plan emphasizing the role of splinting a high-precision and passively fitting implant restoration with reduced micromotion under function is summarized. The reliability and predictability of immediately loaded implants as a treatment option are proposed, and recommended guidelines for the successful delivery of immediately loaded implants in the maxilla are presented.