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Biological and clinical rationale for early implant loading.

This article questions whether early implant loading always leads to pseudointegration, as postulated by Branemark's original protocol, or whether the waiting period of 3 to 6 months can be significantly shortened in specific clinical situations and refined surgical protocols. The rationale for immediate loading of dental implants is discussed, and the evidence that immediate loading leads to implant fibrous encapsulation is reviewed. This evidence is opposed by conflicting indications that early loading induces bone growth. Micro- and macromovement are defined, and their role, as well as the importance of implant surface in the early loading protocol, is discussed. Recently published landmark human clinical trials on early implant loading also are reviewed, along with clinical, surgical, and prosthetic tips to take into consideration when planning an early implant loading case.