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Postponed Loading of One Implant in a Planned Six-Implant-Supported and Early Loaded Full Bridge in the Maxilla

Clinical case by Damiano Verrocchi, DDS and Lars Sennerby, DDS, PhD


Damiano Verrocchi, DDS  Private Practice, San Dona Di Piave and Fiera Di Pimiero, Italy Lars Sennerby, DDS, PhD Private practice, Feltre, Italy and Dept Biomaterials, Gothenburg University, Sweden


Male, 58 years of age, healthy. Periodontally diseased canine to canine in the maxilla. First to first premolar in lower jaw and a removable prosthesis with molars.

Treatment Planning

Extraction of all six teeth in the maxilla and simultaneous placement of six Neoss implants for early loading of a provisional bridge 3 days later.


Bone density is soft in the site for the most distal implant on the right side (position 15). Reduced drill diameter (3.6 mm) for placement of a 4.5 mm wide implant results in acceptable stability (Figure 1a). However, it is suspected that the stability is not sufficient for safe early loading.


ISQ measurements reveal that the ISQ of the implant is 61 which is 12-15 units lower than the remaining 5 implants. It is decided not to include the distal implant in the provisional construction but using a submerged healing period of 4 months. Loading of the bridge is uneventful (Figure 1b). Four months later the distal implant is uncovered and all implants re-measured. The distal implants shows 75 ISQ and the others from 72 to 78 ISQ, indicating that all implants are well integrated (Figure 1c). The permanent construction is made on all six implants (Figure 1d).

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