🦷 Immediate loading is not about speed — it’s about control

Good evening, everyone.

March 23rd, 2026. Just finished dinner — airfryer chicken, simple and effective. At the table, we were discussing football: Porto’s goals against Braga, Sporting vs Alverca… a weekend full of goals.

But today, the real game was different.

On Monday, we received a patient from Algeria, 67 years old, indicated for a full bimaxillary rehabilitation with immediate loading.

A demanding case. But above all, a case about decisions.

🔹 Maxilla — when details change everything

Initial Situation Maxilar Edentulism

The patient presented with a fully edentulous maxilla.

The first decision came early: should we level the ridge or not?

Initially, the answer was no. But when I evaluated the smile line, it became clear there was a subtle — yet real — risk of transition visibility.

And in full-arch rehabilitation, that changes everything.

Additionally, the prosthetic setup was not ideal: there was a small “ledge,” and the ridge was collapsing into the prosthesis. So we moved forward.

We performed a full-thickness mucoperiosteal flap, exposing the anterior wall of the maxillary sinus — a key reference for posterior implant placement — and allowing proper palatal dissection.

This enabled a palatal approach for the anterior implants.

Surgical Procedure Upper Maxilla

👉 Key point: palatal implant positioning should only be considered after proper ridge reduction.

The ridge was leveled using piezo.

For me, the advantages are clear:

• cleaner cut

• better irrigation

• lower morbidity

• 
  

We then moved to implant placement.

Palatal implant positioning combined with a polished collar to manage palatal dehiscence

Initial entry with the spear drill at 45° toward the palate, allowing trabecular anchorage, followed by axis correction toward the palatal access.

Preparation was done with a 2.8 drill for a 3.75 implant, in low-density bone, up to 12 mm depth.

We placed:

• 3.75 x 8 mm implants (active compression)

• Positioned 2 mm subcrestally

• Total anchorage: 12 mm

  
  

Excellent primary stability in sites 12 and 22.

We placed 2.5 mm intermediate abutments.

Posteriorly, the key step was identifying and following the anterior sinus wall as a guide.

Result: parallel, controlled implant positioning with around 70 ISQ.

We used 17° angled multi-unit abutments.

And here, a small detail made a big difference:

Soft Tissue Manipulation . Ridge reduction → palatal implant positioning → soft tissue repositioning.

Every step defines the final result

👉 We repositioned keratinized tissue to the buccal side, using a small incision at the variobase access.

This improves soft tissue sealing and long-term predictability.

Sutures:

• 4-0 posterior

• 5-0 anterior

Healing caps placed.

Maxilla completed.

🔹 Mandible — control starts with anatomy

Dark bone staining from prior endodontic treatment was observed and managed during reduction.

About 30 minutes later, we moved to the mandible.

Different scenario: remaining teeth were present, so we combined extractions with immediate loading.

We performed a full-thickness mucoperiosteal flap.

Careful identification of:

• right mental nerve

• left mental nerve

  
  

Critical step. Always.

Final Closure patient from abroad, resorbable suture although i would prefer on most of the cases Non Absorbable Gore tex suture

We proceeded with extractions and ridge leveling using piezosurgery (mectron), maintaining abundant irrigation and full control.

With the ridge prepared, we placed:

• Two 3.5 BLX x 12 mm implants in the anterior region (lateral incisors)

• Two posterior implants BLX 12 mm 3.5 , positioned between the mental nerve and the canine region

Again, excellent primary stability.

Prosthetic components:

• 3.5 mm SRAs in the anterior region

• Angled multi-units 17º SRA posteriorly

Suturing was done with 4-0 Vicryl resorbable sutures.

The case was then transferred to prosthodontics under optimal conditions.

On a personal note :

Funny how things are .... at the end she ( the Patient) gave a little " souvenir " to dental nurses from the oral surgery, they (the nurses) came to talk to me and said that they should devide with the prostho dental nurses, and i agreed and applaude ( she ( the patient) wanted to give me the souvenir also, but i kindly declined because we are doctors bowed to the ethical hipocrates outh ) so they went and share with them! Because we know that if it were the other way around, they would do the same for them! That's what a team is!

Like Alanis Morissette said one day, and isn´t this ironic, don't you think ?

Have a Nice day !!