2 CLCC 2018 Loading Protocols

Speeding-up procedures?
The impact of loading protocols an

the outcome
Urs Brägger
Department of Reconstructive Dentistry and Gerodontology

School of Dental Medicine
University of Bern, Switzerland 1
2
3
Current definitions of Loading Protocols
in Implant Dentistry
0 1 week 2 months
Immediate Loading Early Loading Conventional

• Within 1 week • between 1 week and 2 loading
months after implant
• 2 months after implant
placement placement
since ITI Consensus Conference 2008, Stuttgart, Germany

and confirmed/ not modified at the ITI Consensus Conference in 2013, Bern, Switzerland
Weber et al. Consensus Statements and Recommended Clinical Procedures Regarding Loading Protocols
IJOMI Vol 24, Supp 2009
4
Agenda
Implant loading Protocols
‣ Definition of Loading Protocols

Consensus Statements and Clinical Recommendations
Implant loading Protocols listed by indications
Esthetic Zone Partially edentulous Fully edentulous
5
Implant Loading Protocols for the Partially
Edentulous Esthetic Zone
Linda Grütter, Urs C. Belser
INT J ORAL MAXILLOFAC IMPLANTS 2009;24(SUPPL):169–179
6
Grütter et al. Implant Loading Protocols for the Partially Edentulous Esthetic Zone. 7
21 studies that reported on 758 implants
• The analysis of the literature on immediately restored or conventionally
loaded implants in the esthetic zone revealed an initial survival rate of 97.3%
after 1 year (10 prospective cohort studies and one case series). For periods
of 1 to 5 years, the survival rate was 96.7%.
• However, for immediately placed implants with immediate restoration and
occlusal loading, the survival rate dropped by approximately 10% (four
studies).
Influence of occlusal contacts,immediate
implantation and loading
Without occlusal contact With occlusal contact
97% survival of implants 89.8% survival of implants
• 24(12-60) months loading • 20 months(12-36) loading
• 21 studies • 4 studies
Implant Loading Protocols for the esthetic zone
ITI Consensus Statements 2008
Conclusion:
• Lack of prospective cohort studies addressing patient-centered
outcomes.
• No parameters specific to immediate loading protocols were available

for evaluation.
• In order to validate or reject such implant protocols for use in the

esthetically sensitive anterior maxilla, long-term clinical trials should
routinely include objective esthetic criteria that comprehensively
embrace the pertinent elements of “pink and white esthetics” in the
form of readily used indices
Grütter et al. Implant Loading Protocols for the Partially Edentulous Esthetic Zone.
11
Recommendations for Immediate Implant
Restoration and Loading
• The implant is of adequate length (≥8 mm) and diameter (≥4 mm)
• The restoration should be taken out of any functional occlusal
contacts both in centric occlusion and during excursive mandibular
movements
• The restoration should not be removed during the healing period of
approximately 6 weeks
• Screw-retained provisional restorations are recommended
• Patients with parafunctional occlusal habits should be fitted with a
habit appliance
• Immediate restoration and loading can be used when the bone
volume at the site is close to ideal- no bone augmentation needed
• “good”primary stability
12
Grütter et al. Implant Loading Protocols for the Partially Edentulous Esthetic Zone.
Primary Implant Stability is dependent on
• bone density
• implant design
• implant surface
• the technique and accuracy of the osteotomy
preparation
Cordaro et al. Implant Loading Protocols for the Partially Edentulous Posterior Mandible
13
Int J Oral Maxillocfacimplants 2009;24(suppl):158–168
Implant Loading Protocols for the Esthetic Zone
ITI Consensus Statements 2013 – Treatment Guidelines
Single edentulous gap:

• For the anterior and premolar regions, immediate and early loading of
single-implant crowns, are predictable procedures in terms of implant
survival and stabilitly of the bone. However data regarding soft tissue
aspects are not conclusive enough to recommend immediate loading
of single implant crowns in esthetically demanding sites as a routine
procedure.
• Immediate loading in such sites should be approached with caution by

experienced clinicians
Gallucci GO, Benic GI, Eckert SE, Papaspyridakos P, Schimmel M, Schrott A, Weber HP. Consensus Statements and Clinical
Recommendations for Implant Loading Protocols.
Int J Oral Maxillofac Implants. 2013 Aug 15. doi: 10.11607/jomi.2013.g4. [Epub ahead of print]
14
Implant Loading Protocols for the Esthetic Zone
Extended Edentulous Sites:

• Immediate loading of anterior implants in extended edentulous sites of
partially edentulous patients should be approached with caution and
by experienced clinicians since insufficient evidence exists to support
such treatment.
• When immediate implant loading is intended, the following criteria

should be considered: primary implant stability, need for substantial
bone augmentation, implant design and dimension, occlusal factors,
patient habits, systemic health, and clinician experience.
Gallucci GO, Benic GI, Eckert SE, Papaspyridakos P, Schimmel M, Schrott A, Weber HP. Consensus Statements and Clinical
Recommendations for Implant Loading Protocols.
Int J Oral Maxillofac Implants. 2013 Aug 15. doi: 10.11607/jomi.2013.g4. [Epub ahead of print]
15
Recommended Clinical Procedures Regarding
Optimizing Esthetic Outcomes in Implant Dentistry
• Immediate loading or restoration of an implant cannot be recommended as a
routine procedure because risks are elevated and esthetic outcomes are
variable.
=> In agreement with previously published ITI documents, early loading of
dental implants in the esthetic zone is recommended.
Morton D, Chen ST, Martin WC, Levine R, Buser D.

Consensus Statements and Recommended Clinical Procedures Regarding Optimizing Esthetic Outcomes in Implant Dentistry.
Int J Oral Maxillofac Implants. 2013 Aug 15. [Epub ahead of print] 16
Protocol University of Bern:
Early Placement & Early Loading: Time schedule
Tooth Extraction Implant Placement Provisional Restoration Final Restoration
Alveolar Socket Healing Period Initial Bone Healing Period Prosthetic Phase
Reopening Soft Tissue Conditioning
Provisional Phase
0 6 - 8w 6 - 8w 3(-5)mo
17
• Buser, Wittneben, Bornstein, Grütter, Chappuis, Belser: Stability of Contour Augmentation
around Single Tooth Implants in the Maxilla using Early Placement. 
3-year Results of a prospective Case Series Study. 
J Periodontol 2011 Mar;82(3):342-9
• Prospective study on 20 patients with 20 single tooth replacements post extraction in the
esthetic zone
• Concept of early implant placement was applied
• Average age of 42 years (range 24-60)
• Standardized surgical procedure (only 1 surgeon)
• Extraction without flap elevation, 6-8 weeks of soft tissue healing
• Placement of bone level implants, simultaneous GBR, primary wound closure, and 8-12
weeks of healing
• Following reopening, provisional restorations with crowns were inserted (Dr. C. Hart; = day 0)
18
Material & Methods

• Prospective 3-year follow up of 20 patients with a single tooth replacement
post extraction in the esthetic zone
• Concept of early implant placement with simultaneous contour augmentation
• Clinical examination up to 3 years
- Typical periodontal parameters
- Bone crest level (DIB)
- PES-WES analysis
- Cast measurements for crown length
19
The pink esthetic score – PES
absent incomplete complete
Mesial Papilla 0 1 2
Distal Papilla 0 1 2
major discrepancy minor discrepancy no discrepancy
Curvature facial mucosa 0 1 2
Level facial mucosa 0 1 2
Root convexity/ Soft-tissue color

0 1 2
and texture
Maximum Total Score 10
- Fürhauser R, Florescu D, Benesch T, Haas R, Mailath G, Watzek G. Evaluation of soft tissue around single-tooth implant crowns: the pink esthetic score. 
Clin Oral Impl Res. 2005
- Belser U, Grütter L, Vailati F, Bornstein M, Weber HP, Buser D: Outcome evaluation of maxillary anterior single tooth implants using objective esthetic criteria. A cross-
sectional, retrospective study in 45 patients with a 2-4 year follow-up using pink and white esthetic scores (PES-WES). J Periodontol 2009
20
The white esthetic score – WES
major discrepancy minor discrepancy no discrepancy
Tooth Form 0 1 2
Outline/Volume 0 1 2
Color (Hue/Value) 0 1 2
Surface texture 0 1 2
Translucency/ Characterisation 0 1 2
Maximum Total Score 10
- Belser U, Grütter L, Vailati F, Bornstein M, Weber HP, Buser D: Outcome evaluation of maxillary anterior single tooth implants using objective esthetic criteria. A cross-
sectional, retrospective study in 45 patients with a 2-4 year follow-up using pink and white esthetic scores (PES-WES). J Periodontol 2009
21
PES 10 PES 5
WES 9 WES 8
22
Table 5. PES and WES of the 20 implant-supported single crowns after 12 and 36 months
3-year examination: The esthetic outcomes are stable
Pink Esthetic Score (PES) White Esthetic Score (WES)
Root
Curvature Level convexity Tooth
Mesial Distal Mean Tooth Surface Trans- Mean Total PES &
Timepoint labial labial Soft tissue Volume/ Colour
Papilla Papilla PES Form Texture lucency WES WES
Mucosa Mucosa colour and Outline
texture
1 year 1.45 1.5 1.75 1.9 1.5 8.1 1.75 1.55 1.4 1.95 2 8.65 16.75
3 years 1.5 1.5 1.7 1.8 1.6 8.1 1.8 1.5 1.4 1.95 2 8.65 16.75
23
Table 5. PES and WES of the 20 implant-supported single crowns after 12 and 36 months
3-year examination: The esthetic outcomes are stable
Pink Esthetic Score (PES) White Esthetic Score (WES)
Root
Curvature Level convexity Tooth
Mesial Distal Mean Tooth Surface Trans- Mean Total PES &
Timepoint labial labial Soft tissue Volume/ Colour
Papilla Papilla PES Form Texture lucency WES WES
Mucosa Mucosa colour and Outline
texture
1 year 1.45 1.5 1.75 1.9 1.5 8.1 1.75 1.55 1.4 1.95 2 8.65 16.75
3 years 1.5 1.5 1.7 1.8 1.6 8.1 1.8 1.5 1.4 1.95 2 8.65 16.75
24
1Table
mos 1 yr
4: Cast analysis regarding the length of the implant crown (IC) and the
contralateral tooth crown (TC) in mm (mean ± standard deviation).
3 yrs
Exam IC TC ΔIC-TC
1 month 9.99 (±0.95) 9.90 (±1.12) 0.09 (±0.58)

TC IC
1 year 10.03 (±1.05) 9.85 (±1.23) 0.18 (±0.58)
3 years 9.94 (±1.04) 9.84 (±1.21) 0.09 (±0.33)
Statistically significant differences between the gingival parameter scores are marked with the same letters
Statistically significant differences between the gingival parameter scores are
IC = implant crown; TC = contralateral tooth;
marked with the same letters 
IC = implant crown; TC = contralateral tooth;
25
3-year examination: The crestal bone levels are stable
26
Prospective Radiographic Examination up to 3 Years
Longitudinal DIB measurements (in mm) Frequency Distribution of DIB
>1
0.51 – 1.00
0.26 – 0.50
0.11 – 0.25
0-0.10
0 2 4 6 8 10 12
Exam 0 mos 3 mos 6 mos 12 mos 36 mos
Mean 0 0.09 0.14 0.18 0.18

Median 0 0 0 0.17 0.10
Maximum 0 0.54 0.90 0.76 0.70
Minimum 0 0 0 0 0
STD 0.00 0.16 0.25 0.20 0.20
27
CONCLUSIONS:
• All 20 implants achieved and maintained successful tissue integration up to 3 years of
follow-up
• At the 3-year follow-up, all 20 implants were successful and fulfilled strict success criteria
• The periimplant bone crest levels around the implants were stable with a mean bone loss
of 0.18 mm at the 3-year examination
• One implant showed bone loss around 1 mm and a gingival recession between 0.5 and
1.0 mm.
• The remaining 19 implants showed no signs of recession at the 3-year follow-up
• Thus, the concept of early implant placement after 6-8 weeks of soft tissue healing offer
predictable esthetic outcomes with a low risk of mucosal recession
28
Agenda

29
Early loading at 21 days of non-submerged
titanium implants with a chemically modified
sandblasted and acid - etched surface:
3-years results of a prospective study
Bornstein M, Wittneben J, Braegger U, Buser D
J Periodontol 2010; 81:809-818
30
• Bornstein M, Wittneben J, Braegger U, Buser D: Early loading at 21 days of non-submerged
titanium implants with a chemically modified sandblasted and acid - etched surface: 3-year
Results of a prospective Study. 
Summary:
• 56 implants were inserted in the posterior mandible in 40 patients
• at day 21 the implants were fully loaded with a provisional crown for 6 months then
final restored
• none of the implants failed to integrate. However two implants were spinners and left
unloaded for an extended period
• 3 year success and survival rate of 100 %
• DIB: 1 year 2.67 mm and after 3 year 2.55 mm
• Comparison SLA vs mod SLA Surface („SLA active“): statistically different for PD and AL
(mod SLA surface having lower PD and AL after 3 years)
31
• Bornstein M, Wittneben J, Braegger U, Buser D: Early loading at 21 days of non-submerged
titanium implants with a chemically modified sandblasted and acid - etched surface: 3-year
Results of a prospective Study. 
Conclusion:
Reduction of the healing period from 6-8 weeks to 3
weeks was primarily possible because of the favorable
ultrahydrophilic properties of the chemically modified
SLA surface
32
33
Evolution in Surface Technology over 35 Years:
from Topography to Chemistry
TPS: 1974 SLA: 1997 SLActive: 2004
Improvement of Improvement of
Macro surface Micro surface chemistry Molecular
topography
34
Immediate and early loading of Straumann
implants with a chemically modified surface
(SLActive) in the posterior mandible and maxilla:
1-year results of a multicenter study
Ganeles J, Zöllner A, Jackowski J, ten Bruggenkate C, Beagle J, Guerra F
Clin Oral Impl Res 2008; 19:1119-1128
35
Immediate vs. early loading with chemically
modified surface implants
• 19 centers in 10 countries
• prospective randomized 3- year study
• 266 patients
• 383 implants
• posterior maxilla & mandible

Immediate and early loading of Straumann implants with a chemically modified surface (SLActive) in the posterior mandible and maxilla.
36
Clin Oral Impl Res 2008: 19: 1119-1128.RCT
138 patients/ 197 Implants Immediate loading (24h)
• Randomization
128 patients/ 186 Implants Early loading (4-5 weeks)
• Single crowns & 2-4 unit FDPs

• No occlusal contacts

37
Survival rates
• 98% immediate
• 97% early
➡no difference

38
Edentulous Posterior Mandible
Luca Cordaro, Ferruccio Torsello, Mario Roccuzzo
INT J ORAL MAXILLOFACIMPLANTS 2009;24(SUPPL):158–168
39
Purpose:
Evaluate the predictability of early and immediate loading protocols of
implants in the posterior mandible
=> To investigate whether there is a difference in success rates, survival

rates, and peri-implant parameters, including marginal bone level
changes, between loading protocols.
Materials and Methods:

Comprehensive systematic review of the literature
40
Results:
A total of 19 papers were selected: 8 on early loading, 9 addressing
immediate loading, and 2 comparing immediate and early loading. Of
the 19 studies, 5 were randomized clinical trials and 14 were
prospective studies.
41
42
=> Early loading in the partially edentulous
posterior mandible at 6 to 8 weeks can be
considered routine in the posterior mandible,
either with single crowns or fixed dental
prostheses.
43
44
Immediate loading in the partially edentulous
posterior mandible proved to be a viable
treatment alternative.
Caution is necessary when interpreting published
outcomes for immediate loading, as the inclusion
exclusion criteria are inconsistent and many
subjective confounding factors are evident.
45
Conclusion:
Additional studies with longer follow-ups, specifically randomized clinical trials,
are needed to consolidate the data for immediate loading. Priority should be
given to trials testing immediate loading.
46
Loading Protocols:
partially edentulous posterior mandible
Implant/prosthetic design
Early loading SCV SCV
Immediate loading CD CD
SCV: scientifically and clinically validated - dark green

CWD: clinically well documented - light green Weber et al. Consensus Statements and Recommended Clinical Procedures Regarding Loading Protocols 47
CD: clinically documented - yellow IJOMI Vol 24, Supp 2009
CID: clinically insufficiently documented - red
Implant Loading Protocols for Partially
Edentulous Maxillary Posterior Sites
Mario Roccuzzo, Marco Aglietta, Luca Cordaro
Int J Oralmaxillofacimplants 2009;24(suppl):147–157
48
Implant Loading Protocols for Partially Edentulous
Maxillary Posterior Sites
Purpose:
Evaluate the predictability of early and immediate loading protocols of
implants in the posterior maxilla
=> To investigate whether there is a difference in success rates, survival

rates, and peri-implant parameters, including marginal bone level
changes, between loading protocols.
Materials and Methods:

Comprehensive systematic review of the literature
Roccuzzo et al. Implant Loading Protocols for Partially Edentulous Maxillary Posterior Sites
49
Int J Oralmaxillofacimplants 2009;24(suppl):147–157
50
Results Early Loading:
• 12 papers: 2 randomized controlled clinical trials
[RCTs], 10 prospective case series studies
• Early loading in the partially edentulous posterior

mandible at 6 to 8 weeks can be considered routine
in the posterior maxilla, either with single crowns or
fixed dental prostheses.
51
52
Results Immediate Loading:
• Six papers: 1 RCT, 4 prospective case series, 1
retrospective study
• Insufficient evidence exists to support

immediate loading of dental implants in the
partially edentulous posterior maxilla
53
Loading Protocols:
partially edentulous posterior maxilla
Early loading SCV SCV
Immediate loading CID CID
CWD: clinically well documented - light green

CD: clinically documented - yellow Weber et al. Consensus Statements and Recommended Clinical Procedures Regarding Loading Protocols 54
CID: clinically insufficiently documented - red IJOMI Vol 24, Supp 2009
And what about conventional loading ?!?
55
Conventional Loading
procedure of choice for partially edentulous sites
(maxilla and mandible) when:
• Stability is considered inadequate for early or immediate loading
• Specific clinical conditions (compromised host and/or implant site,

presence of parafunctions, need of extensive augmentation
procedures, sinus floor elevation)
Weber et al. Consensus Statements and Recommended Clinical Procedures Regarding Loading Protocols 56
Agenda

57
Fully Edentulous
Fixed Options Removable Options

‣ Immediate Loading ‣ Immediate Denture
‣ Stage Approach ‣ Overdenture
58
Fully Edentulous
Removable Options
‣ Immediate Denture
‣ Overdenture
59
Loading Protocols for Mandibular Overdentures
Conventional loading SCV SCV SCV SCV
Early loading CWD CWD CWD CWD
Immediate loading CID CD CD CWD
Two free-standing implants

Bar design over two splinted Four free-standing implants with Locator Bar design over four splinted
Retention with ball or Locator
implants or telescopic crown attachments implants
attachments
Prosthesis Mandibular overdenture Mandibular overdenture Mandibular overdenture Mandibular overdenture
Adequate/reduced interarch
Clinics space
Adequate interarch space Adequate/reduced interarch space Reduced interarch space
SCV: scientifically and clinically validated - dark green

CD: clinically documented - yellow
ITI Treatment Guide Vol 4
60
Loading Protocols for Overdentures in the Maxilla
Conventional loading CWD CWD CD CD
Early loading CD CD CID CID
Immediate loading CID CID CID CID
Bar design (with or without Four free-standing implants with Six free-standing implants with
Bar design over six splinted
Retention cantilevers) over four splinted
implants
Locator or telescopic crown Locator or telescopic crown
implants attachments attachments
Prosthesis Palate-free overdenture Palateless overdenture Palateless overdenture Palateless overdenture
Interarch relation Adequate interarch space Adequate interarch space Reduced interarch space Reduced interarch space

CD: clinically documented - yellow
ITI Treatment Guide Vol 4
61
Fully Edentulous
Fixed Options
‣ Immediate Loading
‣ Staged Approach
62
Loading Protocols for Maxillary Fixed Rehabilitation
Conventional loading CD SCV SCV SCV
Early loading CID CD CD CD
Immediate loading CID CWD CWD CWD
Implant number and Four anterior Six anterior Six anterior-posterior Eight anterior-posterior
distribution
Full-arch with distal Full-arch with distal Segmented in four three-unit
Prosthesis cantilevers cantilevers
Full-arch
FPDs*
Increased interarch space, Increased interarch space, Increased interarch space, adequate Increased interarch space,
Clinics adequate bone volume in adequate bone volume in bone volume in the anterior/posterior adequate bone volume in
the anterior maxilla the anterior maxilla maxilla the anterior/posterior maxilla
SCV: scientifically and clinically validated - dark green * The segmentation design represents the final prosthesis. For fixed transitional prosthesis a full-arch one-piece is indicated.
CD: clinically documented - yellow ITI Treatment Guide Vol 4
63
Loading Protocols for Mandibular Fixed Rehabilitation
Conventional loading CWD SCV SCV SCV
Early loading CD CD CD CD
Immediate loading CD CWD CWD CWD
Implant number and Four anterior Six anterior Six anterior-posterior Eight anterior-posterior
distribution
Full-arch with distal Full-arch with distal
Prosthesis cantilevers cantilevers
Full-arch in one piece Segmented into three FPDs*
Increased interarch space, Increased interarch space, Increased interarch space, adequate Increased interarch space,
Clinics adequate bone volume in adequate bone volume in bone volume in the anterior/posterior adequate bone volume in
the anterior maxilla the anterior maxilla maxilla the anterior/posterior maxilla
SCV: scientifically and clinically validated - dark green * The segmentation design represents the final prosthesis. For fixed transitional prosthesis a full-arch one-piece is indicated.
CD: clinically documented - yellow ITI Treatment Guide Vol 4
64

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Speeding-up procedures?

The impact of loading protocols an

Department of Reconstructive Dentistry and Gerodontology

Immediate Loading Early Loading Conventional

since ITI Consensus Conference 2008, Stuttgart, Germany

‣ Definition of Loading Protocols

Esthetic Zone Partially edentulous Fully edentulous

Linda Grütter, Urs C. Belser

INT J ORAL MAXILLOFAC IMPLANTS 2009;24(SUPPL):169–179

Without occlusal contact With occlusal contact

97% survival of implants 89.8% survival of implants

• 24(12-60) months loading • 20 months(12-36) loading

• No parameters specific to immediate loading protocols were available

• In order to validate or reject such implant protocols for use in the

Single edentulous gap:

• Immediate loading in such sites should be approached with caution by

Extended Edentulous Sites:

• When immediate implant loading is intended, the following criteria

Morton D, Chen ST, Martin WC, Levine R, Buser D.

Tooth Extraction Implant Placement Provisional Restoration Final Restoration

Reopening Soft Tissue Conditioning

Material & Methods

major discrepancy minor discrepancy no discrepancy

Curvature facial mucosa 0 1 2

Level facial mucosa 0 1 2

Root convexity/ Soft-tissue color

major discrepancy minor discrepancy no discrepancy

Maximum Total Score 10

3-year examination: The esthetic outcomes are stable

Pink Esthetic Score (PES) White Esthetic Score (WES)

3-year examination: The esthetic outcomes are stable

Pink Esthetic Score (PES) White Esthetic Score (WES)

1 month 9.99 (±0.95) 9.90 (±1.12) 0.09 (±0.58)

3 years 9.94 (±1.04) 9.84 (±1.21) 0.09 (±0.33)

Exam 0 mos 3 mos 6 mos 12 mos 36 mos

Mean 0 0.09 0.14 0.18 0.18

Maximum 0 0.54 0.90 0.76 0.70

STD 0.00 0.16 0.25 0.20 0.20

‣ Definition of Loading Protocols

Esthetic Zone Partially edentulous Fully edentulous

Ganeles J, Zöllner A, Jackowski J, ten Bruggenkate C, Beagle J, Guerra F

• Single crowns & 2-4 unit FDPs

Ganeles J, Zöllner A, Jackowski J, ten Bruggenkate C, Beagle J, Guerra F

Ganeles J, Zöllner A, Jackowski J, ten Bruggenkate C, Beagle J, Guerra F

Luca Cordaro, Ferruccio Torsello, Mario Roccuzzo

INT J ORAL MAXILLOFACIMPLANTS 2009;24(SUPPL):158–168

=> To investigate whether there is a difference in success rates, survival

Materials and Methods:

Early loading SCV SCV

SCV: scientifically and clinically validated - dark green

Mario Roccuzzo, Marco Aglietta, Luca Cordaro

Int J Oralmaxillofacimplants 2009;24(suppl):147–157

=> To investigate whether there is a difference in success rates, survival

Materials and Methods:

• Early loading in the partially edentulous posterior

• Insufficient evidence exists to support

Early loading SCV SCV

Immediate loading CID CID

CWD: clinically well documented - light green

• Stability is considered inadequate for early or immediate loading

• Specific clinical conditions (compromised host and/or implant site,

‣ Definition of Loading Protocols

Esthetic Zone Partially edentulous Fully edentulous

Fixed Options Removable Options