Who Is Immediate Loading For — and Who Is It Not For

Controlled diabetes — yes, with no special protocol. Uncontrolled diabetes — control first. The reason: high sugar slows wound healing and raises the risk of infection and of an implant that doesn’t take. What we ask for: a recent HbA1c, and we look at the range your treating doctor approves, usually up to about 8%. If you’re above it, we’ll ask you to work on it with your GP or endocrinologist before we set a date for surgery; the consultation and planning can happen now. On the day of surgery you take your medication as usual and eat breakfast — don’t come fasting. Bring your medication list and your latest result to the consultation; it saves a round trip.

It doesn’t rule you out, but we’ll say it straight: smoking lowers implant success rates and slows healing, and in the first days after surgery it’s the most common cause of a wound infection. What genuinely helps is stopping, even temporarily: at least two weeks after surgery, and a month if you can manage it. Cutting down around the surgery and the months of fusing improves the odds too. A heavy smoker who has no intention of stopping — still possible, but we’ll talk about it honestly at the consultation, and sometimes we’ll prefer six implants instead of four, or the delayed protocol. If you know you won’t manage to stop, tell us before, not after. There are things we can do about it.

Almost never. Our first question will be: based on what? A panoramic X-ray shows height roughly and doesn’t show width at all, and people are told “there’s no bone” without a 3D scan. Only a CT measures. And the second question: where is it missing? Thin bone at the back is the normal state after years without teeth, and that’s exactly what the tilted implants of All-on-4 are for — they use the bone that’s left at the front. There are also short implants (6–8 mm) and narrow ones, and a closed sinus lift that adds 2–4 mm at the same visit. A large bone graft is kept for the places where there’s genuinely no alternative. We’ve seen “no bone” jaws get a fixed bridge. Bring your CT, or take a referral, and we’ll look together.

It depends which drug, in what form, and for how long. Bisphosphonate tablets (Fosalan, for example) for a short period — usually possible, with care and follow-up. After many years on tablets, or when the drug is given intravenously, or with denosumab injections (Prolia) — a thorough work-up is needed: the risk of a healing problem in the jawbone is higher, and sometimes we coordinate a pause or the timing around the injection with your treating doctor. It isn’t decided over the phone. What you shouldn’t do is stop a drug yourself before the consultation. Bring the full medication list with doses and start dates, and a letter from your endocrinologist if you have one. The consultation and planning can go ahead regardless; only the surgery date waits for the work-up.

You’re not alone — a good share of the people who come to us came precisely because of years of putting it off out of fear. A few things help. First: the protocol itself is short — one operation instead of a series of treatments, and for many people that’s already half the solution. Second: sedation with an anaesthetist, arranged in advance; you sleep, you wake up when it’s all over, and you don’t remember. Third: the explanation. At the consultation we go through exactly what will happen, step by step, and in the room we tell you before every single thing what we’re about to do. You can raise a hand and stop. You can bring someone with you. And if you’d rather just come for a talk with no exam the first time — that’s fine too; tell the call centre.

Blood pressure controlled by medication — no. On the day of surgery you take your pills as usual, eat breakfast, and we measure before we start; if the reading is too high that morning we sometimes postpone, so it’s worth sleeping well the night before. Blood thinners (Coumadin, Eliquis and the like) — in most cases we don’t stop them; with Coumadin we check the INR a day or two before, and with the others we sometimes arrange skipping a single dose with your treating doctor, and control any bleeding locally. Never stop a blood thinner on your own before surgery. Bring an up-to-date medication list to the consultation, and if you have a cardiologist, a letter from them too.

Less than there was, for sure. The jawbone exists to hold teeth, and when there are no teeth it resorbs — up to half its width in the first year, and more slowly after that. A denture speeds that up, because it presses on the ridge without passing any load into the bone, and after 20 years the lower jaw is sometimes very thin. But: the loss is mainly at the back. At the front, between the two openings of the nerve, there’s almost always bone left — and that’s exactly where the tilted implants of All-on-4 go in. We’ve seen jaws described as “no bone” get a fixed bridge. There’s also an overdenture on two implants, which needs even less. What we won’t say without a CT is exactly how much is left. Bring the denture to the consultation — it tells us a lot.

Then we wait. Not because of the implant itself but because of three things around it: the CT scan, the anaesthesia, and the medication afterwards — painkillers and sometimes antibiotics. None of them is done in pregnancy without urgent need, and an implant isn’t urgent. What can happen now: a consultation. If you have a CT from before the pregnancy, bring it and we plan on that; if not, we have a conversation and a clinical exam without a scan, and complete the CT after the birth. That way the plan and the quote are ready, and after the birth, in coordination with your doctor, we set a date. A tooth that hurts or is infected in pregnancy is another matter, and that does get treated; for that, go to your dentist — don’t wait.