Immediate loading: what the lab needs from you

What counts as immediate loading, and how long does the lab have?

The ITI (International Team for Implantology) defines immediate loading as a prosthesis in function less than one week after implant placement. One week to two months is early loading; beyond two months, conventional. For the lab, that one-week window is the whole schedule: the immediate-load prosthesis has to be ready inside it, which is why the surgery date gets agreed in advance.

The evidence for full arches is solid. The 2013 ITI consensus found immediate loading with a one-piece fixed interim prosthesis as predictable as early or conventional loading, in both the mandible and the maxilla. Most of the included studies required insertion torque of at least 30 Ncm, ISQ of at least 60 and implants 10 mm or longer. The same consensus treats simultaneous grafting or sinus elevation as a relative contraindication. That assessment is a surgical one, and it’s yours. What follows is the lab side.

What do you send the lab, and when?

A full-arch immediate load involves three hand-offs to the lab: before surgery, right after it, and when you move to the final. The table sums them up; the sections below explain why each item matters.

What does the lab need before surgery?

Before an immediate-load surgery, the lab needs to know when it happens and where the teeth are going. Before surgery day, send:

• The surgery date, agreed with us. Turnaround is set from it when the case is opened.
• A tooth reference: a scan of the patient’s current denture, a setup you’ve approved, or photos at rest, smiling and in profile.
• A VDO and jaw relation reference. Once the teeth are extracted, the landmarks that held the vertical dimension are gone, so the reference has to be recorded first.
• Tooth shade on a guide and, if relevant, the gingival shade you want.
• For guided cases, the plan and the surgical guide, with implants and abutments already selected in the software.

What does the lab need after surgery?

After surgery, the lab needs the actual position of each implant, captured at the multi-unit abutment level. Digitally, that’s a scan with scan bodies threaded onto the abutments; conventionally, an impression with copings and the analogs. Along with it:

• Implant brand and platform, multi-unit abutment brand and system, and each abutment’s cuff height and angle, with tooth positions.
• The opposing arch and a bite registration at the agreed VDO.
• Photos of the patient with the current denture or the tried-in setup.

We check every case when it arrives. If anything on this list is missing, the case waits there until you reply, and inside a one-week window that matters. Our guide to what holds up a lab case covers what most often goes missing from the order.

Convert the denture or order a milled provisional?

Converting the patient’s denture and ordering a milled PMMA provisional both work for immediate loading; they differ in strength, planning and chair time. Nagai and colleagues (Dentistry Journal, 2026) compared four conversion techniques in clinical cases and laid out the trade-offs.

Material strength backs this up. Angelara, Bratos and Sorensen (The Journal of Prosthetic Dentistry, 2023) point out that the holes cut to capture the cylinders weaken a converted denture. In their in vitro test, prostheses milled from high-density PMMA blanks had 35% higher flexural strength than heat-processed denture base resin, both between abutments and on the cantilever.

A provisional can also be made before surgery. Makarov, Pompa and Papi (International Journal of Implant Dentistry, 2021) planned 10 guided cases and milled the PMMA provisionals ahead of time. In every case the titanium cylinders seated without enlarging the access holes, and the prostheses went a full year in function without a fracture.

Which of these routes the lab takes on your case, including having the provisional ready before surgery, is agreed when the case is opened, along with the date.

What is an immediate-load PMMA provisional like?

An immediate-load PMMA provisional is a screw-retained full-arch implant bridge on the multi-unit abutments, milled in PMMA. Garza and colleagues (Materials, 2025) followed 72 of these in a fully digital workflow for three months: none fractured or suffered irreparable damage.

When the agreed route is a milled provisional, we design and mill it in-house; every stage is validated and logged, and the prosthesis goes through eight checks before it ships. The service itself is described under immediate-load prosthesis.

How do you move from the provisional to the final prosthesis?

When you move to the final prosthesis, treat the provisional as the rehearsal. The tooth position, VDO, lip support and phonetics that worked in it are the best reference for the final, and the lab can only carry them over if it receives a record of the provisional.

When you’re ready for the final, after osseointegration, send:

• A new scan with scan bodies on the multi-unit abutments, or an impression with copings.
• A scan of the provisional, in the mouth and out of it, plus notes on what to keep and what to change.
• The opposing arch, a bite registration and photos with the provisional in place.

Choosing the final material is a separate decision. Our piece on full-arch zirconia, titanium bar or PMMA compares the options. The full-arch zirconia bridge and PMMA full-arch bridge pages cover each one. The general checklist lives in our guide to sending a case to the lab.