The majority of clinical reports reveal similar survival rates between immediate-loaded and 2-stage-unloaded healing approaches in the completely edentulous patient. In our prospective study, 31 arches received immediate-loaded restorations in 30 patients, supported by 244 implants. All implants were followed a minimum of 2 years after prosthesis delivery to as long as 6 years. The implant and final prosthesis survival were 100% during this time frame. Nonetheless, these findings do not imply a submerged surgical approach is no longer necessary or prudent in many cases. Future studies may find indications based upon surgical, host, implant, and occlusal-related conditions more beneficial for one versus the other. The strength of bone and the modulus of elasticity are both directly related to bone density. The softest bone type may be 10 times weaker than the most dense types. The microstrain mismatch of titanium and the softest bone is much greater than with the densest bone. As a consequence, higher implant failure and greater crestal bone loss seem likely but as yet has not been reported in the literature. A biomechanical treatment approach to increase surface area and decrease forces applied to the immediate restorations is logical to increase implant survival. Conditions that decrease strain to a developing interface include increasing implant number, implant size, and implant thread number and depth. Patient factors such as parafunction may increase forces to the implant interface, while implant position may be used to decrease forces, especially when a splinted arch form is created. Tables 3 and 4 list guidelines for immediate occlusal loading. As a general principle, the clinical should be able to increase surface area while minimizing occlusal force to ensure long-term success.

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