DISCUSSION.
Immediate implant loading has been controversial during the last 15 years. However, functional immediate loading has gained much greater acceptance during the past three. The implant case presented (as an example based on ten years of experience applying functional loading) demonstrates that osseointegration and immediate loading are not contradictory. Quite the opposite is the case. If there is a functional stimulus on the fixtures, physiologic healing can be seen at the implant sites.
Initial stability of implants is a sine qua non for this treatment concept. If initial stability is not achieved, it is impossible to practice immediate loading. Application of the lateral, microsurgical insertion technique in severe bone atrophy and type IV bone makes initial implant anchoring in cortical bone possible, provided that the drilling procedure, using titanium cutters mounted on a turbine, is performed precisely. Further, the placement of disk-design implants causes a primary bone healing in the area around the disks, which shortens the entire treatment procedure. After immediate functional loading with fixed esthetic temporaries almost 40 days after the procedure, the definitive restorations can be fabricated. Osseointegration of implants is a not a static state but a balance between bone formation and bone loss. To maintain this balance (to gain long-term implant success), the forces on the prosthetic superstructures and the implants have to be observed. Bone loss in the area around the implants or even implant fractures are possible if the forces are too strong. Therefore, the positioning of the implants in the arch and the morphological forms of the occlusal surfaces of supraconstructions are most important.
The following aspects must be observed for the proper fabrication of implant restorations:

1. reduced occlusal surfaces;
2. disclusion in group function;
3. no prematurities during function and maximal intercuspation.

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