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Treatment Algorithm · Module
How soon to load: immediate, early, or conventional
Selecting a loading protocol from primary stability and site factors. Anchored to ITI consensus definitions, using insertion torque and ISQ as the gatekeepers for accelerated loading.
Use: Restorative timing reference
Gatekeepers: Torque + ISQ
Framework: ITI consensus
01 — Definitions
The three loading protocols
Loading is defined by the interval between implant placement and connection of a load-bearing restoration. Definitions follow ITI consensus.
Protocol
Immediate loading
- Restoration in occlusion < 1 week (often < 48–72 h)
- Requires high primary stability
- Torque ≥ 35 Ncm and/or ISQ ≥ 70
- Best in dense bone, splinted, controlled occlusion
Protocol
Early loading
- 1 week – 2 months after placement
- Moderate stability acceptable
- ISQ ~65–69 trends toward early
- Reassess stability before loading
Protocol
Conventional loading
- > 2 months (≈ 3–6 mo)
- Default when stability is low
- Soft bone, augmented sites, risk factors
- Most predictable osseointegration window
02 — Decision Pathway
Interactive loading selector
Measure stability at placement. Insertion torque and ISQ are the primary gate; site, bone quality, and occlusion modify the decision.
Tap the stability band recorded at placement.
Step 1 — What is the primary stability?
HIGH
ISQ ≥ 70 and/or torque ≥ 35 Ncm
Favorable bone, controllable occlusion.
MODERATE
ISQ 65–69 / torque 25–34 Ncm
Adequate but not maximal stability.
LOW
ISQ < 60 / torque < 25 Ncm
Soft bone, grafted site, or risk factors.
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03 — Modifiers
Factors that override the stability reading
High ISQ alone does not justify immediate loading if other factors are unfavorable. Treat any "defer" finding as a reason to step down a protocol.
| Factor | Supports faster loading | Defer / step down |
|---|
| Bone quality | Type I–II (dense) | Type IV (soft, post. maxilla) |
| Augmentation | Native bone | Simultaneous graft / sinus lift |
| Occlusion | Out of function, no parafunction | Bruxism / heavy occlusion |
| Splinting | Cross-arch / splinted units | Single posterior unit |
| Patient risk | Healthy, non-smoker | Smoker, poorly controlled diabetes |
Reference
Sources & clinical disclaimer
For licensed clinicians — educational use only. This algorithm summarizes published consensus and is not a substitute for individual clinical judgment, examination, or the standard of care in your jurisdiction. ISQ/torque thresholds vary by implant system — follow manufacturer instructions.
- Gallucci GO, et al. Implant placement and loading protocols in partially edentulous patients — ITI Consensus. Clin Oral Implants Res. 2018;29(Suppl 16):106–134.
- Morton D, et al. Group 2 ITI Consensus Report: prosthodontics and loading protocols. Clin Oral Implants Res. 2018;29(Suppl 16):215–223.
- Bavetta G, et al. Insertion torque and ISQ as stability parameters for immediate loading. Biomed Res Int. 2019;2019:9720419.
Last reviewed: June 2026 · Next review due: June 2027 · Version 1.0