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Bite Force Measurements and Immediate Loading


Bite Force and Immediate Loading Image

It’s easy to see why patients request immediate loading of dental implants.


Many patients say they prefer the ease of a single visit, without the risk of repeated surgeries and the potential cost of temporary aesthetic solutions. (Hof, Tepper, et al, 2014).


As a practitioner, you may also prefer to offer immediate loading whenever possible. It involves less surgical intrusions and – by maintaining existing soft tissue shape – typically offers patients improved aesthetic results.


So why don’t practitioners use immediate loading for more implants? The risk of failure.


Failure can happen at any stage of implantation and can be caused by many factors. A lack of patient suitability is high on the list. Other causes include contamination, infection, peri-implantitis, trauma during or after surgery, and inadequate healing. (Kang, Kim, et al 2019) On top of these, immediate loading brings increased risk. A 2019 study found that immediately-loaded implants were 2.7 times more likely to fail at one-year compared to delayed-loaded implants. (Susarla, Chuang, Dodson)


Occlusal overload is a potential cause of failure after immediate loading, and some practitioners have begun to address this risk through bite force measurements. (Flanagan, 2017)


Bite force capability is very important to me in my full arch dental implant practice. Being able to quantify whether somebody has a “strong bite” has been extremely useful, especially for immediate loading full arch implants.
It lets me and my patient assess immediate loading risk before doing treatment. I am able to provide options or therapy to those that may destroy the prosthesis or cause implant failure. I no longer have to wonder if the bite is strong…now I measure it with the Innobyte!!

Ramsey Amin, D.D.S.

Diplomate of the American Board of Oral Implantology /Implant Dentistry

Fellow of the American Academy of Implant Dentistry

Burbank Dental Implants


dentist holding dental implant

How can bite force measurements improve treatment outcomes for dental implants?

  • Bite force measurements can be taken pre-treatment to assess potential occlusal overload

  • For patients with high bite forces, a treatment plan and personalized materials selection can help mitigate risk of failure

  • For patients with excessively high bite forces and risk of occlusal overload following immediate loading, the use of Botox may reduce forces on the new implant during osseointegration


How can bite force measurements improve communication with patients and treatment acceptance?


Bite force measurements are not only useful when determining a treatment plan. They also can be a key tool in helping your clients understand your recommendations:

bite force reference values


For patients with a high bite force:

Show the patient their bite force measurement result, and explain where this measurement falls relative to a normal result. Explain your specific treatment strategy, which may include material selection, implant length, numbers and position, or the use of Botox to improve chances of a positive outcome.


For patients with a low bite force:

Show the patient their existing bite force and potential for post-treatment improvement in diet and quality of life.



dentist showing patient new implants

Innobyte Bite Measurement Device


The longevity of restorations can be directly related to the forces that they must endure during function. Until now, it has not been possible to accurately measure the bite forces that patients generate. A new device has been created that measures this force, and with experience, proper restorative and prosthodontic materials can be prescribed based on bite force.
In addition, the measurement values can be used to explain to patients during the treatment planning phase how their bite force rejuvenation can occur once they are restored to proper function.

Dr. Elahe Behrooz and Dr. Izchak Barzilay,

Prosthodontic Associates

Toronto, Canada



The Innobyte Bite Measurement device is precise, reliable, and easy to use. It allows you to measure your patient's maximal bite force in less than 3 seconds, providing clear data to you and your patient.

  • Demonstrate unequivocally the need for treatment

  • ​Decide type of treatments and which materials to use

  • ​Increase treatment plan acceptance rates

Learn more about the Innobyte Bite Force Measurement Device today!


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DR. SIMON OH, DDS FICOI

Chief Clinic Officer and Chief of Implantology ProSmile

DR. JUSTIN LE

Digital Restorative Dentist at Smart Arches

Sunday September 17, 2023 

6:00 PM (CST) 

1 FREE CE CREDIT! 

 

Immediate Loading Frequently Asked Questions [FAQ]


What is Immediate Loading?

Dental implant placement is typically a 2-step process – implantation of a dental screw into the jaw bone, and then loading of the prosthetic tooth onto the screw. With Immediate Loading, the prosthetic tooth is added immediately after the implant surgery.


What is the difference between Immediate Loading of Implants (ILI), Early Loading (ELI) and Conventional Loading (CLI)?

In Conventional Loading methods, the prosthetic tooth is added several months after implantation, allowing time for the implant screw to fuse with surrounding bone – creating structural integrity through a process known as osseointegration.

Early loading is done between 1 week and 2 months after implant placement.

With Immediate Loading, the prosthetic tooth is added in the same appointment as the implant surgery, or up to one week after implant surgery.


What are the advantages of Immediate Loading?

Patients and practitioners say they prefer Immediate Loading because:

The prosthetic tooth is installed within existing soft tissue shape, which typically offers patients improved aesthetic results

The work is done in a single treatment visit, offering greater convenience

There is less need for multiple surgeries, reducing risk of repeated intrusions

There is no need for temporary teeth or other temporary aesthetic solutions, lowering patient costs

(*Tepper, Semo et al 2014)


What are the disadvantages to Immediate Loading?

Immediate loading can increase the risk of implant failure. A 2019 study found that immediately-loaded implants were 2.7 times more likely to fail at one-year compared to delayed-loaded implants. (Susarla, Chuang, Dodson)

Since occlusal overload is a potential cause of implant failure after immediate loading, some practitioners assess this risk through bite force measurements. (Flanagan, 2017)


Can a patient’s bite force be too high for Immediate Loading?

Yes, patients with a bite force over 1,000 newtons are at a high risk of implant failure, particularly after Immediate Loading.


Can you do Immediate Loading on patients with excessive bite forces?

To reduce the risk of implant failure, some practitioners inject Botox into the mandibular joint to lower a patient’s bite force. This may lower occlusal forces and reduce implant movement, potentially improving osseointegration.


 

Bite Force Measurements and Immediate Loading Resources:


Flanagan D. Bite force and dental implant treatment: a short review. Med Devices (Auckl). 2017 Jun 27;10:141-148. doi: 10.2147/MDER.S130314. PMID: 28721107; PMCID: PMC5501108.


Hof M, Tepper G, Semo B, Arnhart C, Watzek G, Pommer B. Patients' perspectives on dental implant and bone graft surgery: questionnaire-based interview survey. Clin Oral Implants Res. 2014 Jan;25(1):42-5. doi: 10.1111/clr.12061. Epub 2012 Oct 17. PMID: 23075114.


Kang DW, Kim SH, Choi YH, Kim YK. Repeated failure of implants at the same site: a retrospective clinical study. Maxillofac Plast Reconstr Surg. 2019 Jul 10;41(1):27. doi: 1www.iosrjournals.org0.1186/s40902-019-0209-1. PMID: 31355159; PMCID: PMC6616583.


Reddy Vootla N, Reddy KV. Osseointegration- Key Factors Affecting Its Success-An Overview. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 16, Issue 4 Ver. V (April. 2017), PP 62-68 https://www.iosrjournals.org/iosr-jdms/papers/Vol16-issue4/Version-5/N1604056268.pdf


Susarla SM, Chuang SK, Dodson TB. Delayed versus immediate loading of implants: survival analysis and risk factors for dental implant failure. J Oral Maxillofac Surg. 2008 Feb;66(2):251-5. doi: 10.1016/j.joms.2007.09.012. PMID: 18201604; PMCID: PMC5560427.


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