In recent years on the implantoprosthetic scene there is an ever increasing use of the post-extraction implant prosthesis with immediate loading. In this context the method of distal implants positioned in an inclined position is frequently adopted; this is indicated when there is bone atrophy in the rear sectors with consequent anatomical problems regarding the position of the emergence of the alveolar nerves and pneumatisation of the maxillary sinus.
This type of operation is necessary when it is not possible to consider the resolution, with bone regeneration, of the lower and upper rear atrophies. Although the positioning of the inclined distal implants in the operative phase and of the more medial implants in a position perpendicular to the crest may seem fairly facilitated by the quantity and by the stable type of bone present in the pre-extraction phase, numerous problems often occur connected to problematic conditions in the surgical phase.
The factors to be respected for immediate loading in fact require absolute primary stability, but they do not exclude those fundamental principles for aesthetic requirements, the creation of the temporary prosthesis in a short space of time, post-operative comfort, etc.
Numerous difficulties may be encountered especially when, in the post-extraction phase, we find various bone complications determined by the prolongation of inflammatory and infective factors; these are represented, on the alveolar bone, by gaps and atrophies of various kinds that cause variations in the form of the three planes of the space in the bone where we have to position the implants. This problem will inevitably influence the stability, the aesthetic aspect and the need to deliver an immediate temporary prosthesis in a short time.
This work analyses the fundamental factors of the pre-surgical phase in chronological order, so as to obtain a protocol that acts as a guide to as predictable a result as possible and allows a linear and facilitated execution that ensures the rehabilitations will be long-lasting.
The author concludes by indicating the validity of post-extraction implant prosthesis with immediate loading as regards both the functional and aesthetic aspect and long duration.
Correct planning and programming of the prosthesis are important, taking into account a correct analysis in the phase of the anamnesis and pre-surgical planning.
