How long to wait before restoring a dental implant?


I have been restoring dental implants for about 15 years. In the early 90’s there was a fear that the implant might fail, so the clinicians of the day would wait a long time and then load the implant with a temporary crown. So in all, it might take a year or more before the final crown was placed on the tooth.

In this society, nobody really wants to wait for anything, so research has shown that 3-6 months works well in most cases.

It is possible to load implants with a temporary crown almost immediately before osseointegration (the fusing of the titanium implant to the bone) has occurred. In this case the bite must be relieved so that the implant is  not disturbed during this healing phase. If the implant comes loose, it must be removed, bone grafting material placed, and you get to start over again. This can add another year or so to the procedure.

The first case I want to mention is that of a male patient in his early 60’s. He was going out of town for a few months and wanted to have his implant in the upper second molar position cemented a little earlier than we would normally do. The surgeon gave his approval, so we went ahead. While torqueing the implant abutment in the implant (this is the middle part which the crown attaches to), the implant was not secure enough to withstand the torque and came loose. He was understandably not happy and took a year to be able to get the new implant and crown. It has been stable for 10 years since that time.

I recently had a case where a patient was getting a 3 unit bridge on her upper anterior teeth, totally implant supported. 3 months after the implant surgery, the surgeon performed his tests and could tell that one of the implants did not have the bone and implant integrate sufficiently. So, we waited another 8 months during which time the patient had a temporary bridge. When we finally torqued the implant abutments into place with no problems, there was a huge sigh of relief. Had we not had that data, the torque would have failed and we would be back to the beginning.

Another 2 patients were wearing a removable partial denture (flipper) to replace an upper first premolar. This prosthesis, if in contact with the top of the implant, can cause a problem and delay the healing process. In one case the implant came out at the torqueing stage, and with the other similar to this the partial was further adjusted and we waited longer. Both of these cases are now doing just fine.

So, to do a good and easy job, there are several factors that go into deciding when to do the final restoration of the implant. Sometimes it’s worth waiting a little longer to give a better chance of success. The new technology, particularly CT scans that surgeons have, really make a difference in making good decisions in timing. That’s why I always wait for the blessings of the surgeon before proceeding with the restoration of these implants.