"Same-day teeth" — also marketed as teeth-in-a-day — is one of the most searched terms in dental tourism. The appeal is obvious: arrive in Antalya, have surgery in the morning, leave with a full set of fixed teeth by evening. At Taki Dent, we perform immediate loading procedures regularly. But I turn away approximately 30% of the patients who request it, because they do not meet the clinical criteria — and proceeding with immediate loading in an unsuitable patient is one of the most reliable ways to generate an implant failure.
What Immediate Loading Actually Means
Immediate loading means placing a provisional or definitive prosthesis on the implants within 48 hours of surgery — before osseointegration has occurred. The implants are in bone, but the bone has not yet grown intimately onto the implant surface. The prosthesis is held in place entirely by the mechanical engagement of the implant threads in the bone — what we call primary stability.
During the healing period following immediate loading, any micro-movement of the implant within the bone greater than approximately 100–150 micrometres will trigger fibrous encapsulation rather than bone formation. This is an implant failure — and in an All-on-4 or All-on-6 scenario where a cross-arch bridge splints all implants together, one failing implant can compromise the entire reconstruction.
The ISQ Value: The Key Measurement
Implant Stability Quotient (ISQ) is measured using resonance frequency analysis (RFA). I use an Osstell device in every implant case. The ISQ scale runs from 1 to 100; higher values indicate greater stability. The device works by vibrating the implant via a magnetic peg and measuring the resonance frequency — stiffer, better-integrated implants resonate at higher frequencies.
My ISQ Thresholds for Immediate Loading
These are guide thresholds. Clinical decision-making integrates ISQ with insertion torque, bone type, patient factors, and arch position.
Insertion Torque: The Second Measurement
Insertion torque (IT) is the resistance the bone offers as the implant is driven to final position. I measure this in Newton-centimetres (Ncm). For immediate loading in an All-on-4 case, I require all four implants to achieve a minimum insertion torque of 35 Ncm, with the posterior angled implants ideally exceeding 40 Ncm. Implants seated below 25 Ncm will not be immediately loaded regardless of ISQ.
There is nuance here: very high insertion torques (above 70–80 Ncm) can actually be counterproductive — they may indicate that the implant is compressing bone rather than engaging it predictably, which can cause pressure necrosis and reduce secondary stability. The ideal range is 35–60 Ncm for most immediate loading cases.
Patient Factors That Disqualify Immediate Loading
Even if primary stability measurements are adequate, I will not immediately load in the following clinical situations:
- Uncontrolled bruxism: The parafunction forces during the healing period will generate micro-movement that exceeds safe thresholds, regardless of how good the primary stability is.
- D3/D4 bone in the maxilla: Soft maxillary bone rarely achieves the insertion torques needed for immediate loading. I routinely stage these cases with delayed loading protocols.
- Active infection at the surgical site: Immediate post-extraction implants in infected sockets require socket debridement and should be assessed individually — immediate loading in contaminated sites increases failure risk significantly.
- Uncontrolled diabetes (HbA1c > 8.5%): Impaired wound healing and bone metabolism make the osseointegration window unpredictable.
- Bisphosphonate or RANKL inhibitor therapy: Risk of medication-related osteonecrosis of the jaw (MRONJ) is a serious concern. Any patient on these drugs requires specialist assessment before implant surgery.
What Happens in Delayed Loading Cases
When I recommend delayed loading, it means the implants are placed and left to osseointegrate under cover screws or healing abutments for 3–4 months (mandible) or 5–6 months (maxilla). The patient wears a temporary removable denture during this period. At the second-stage appointment, ISQ is re-measured — secondary stability will typically have risen above 70 — and the definitive or provisional prosthesis is then fitted.
I know this is not what many patients want to hear when they have planned a trip to Antalya expecting to leave with fixed teeth. But the alternative — proceeding with immediate loading on borderline bone, then experiencing implant failure, needing explantation and augmentation, and returning for a third surgical procedure — is far more disruptive. The delayed protocol, presented honestly at the outset, is a better outcome for the patient.
The Provisional vs Definitive Distinction
Even when immediate loading criteria are met, the day-of-surgery prosthesis is always a provisional restoration in my practice — typically a PMMA (acrylic) bridge that is lighter, easier to adjust, and absorbs more impact than the final ceramic prosthesis. The definitive zirconia bridge is fitted at approximately 4–6 months post-surgery, once osseointegration is confirmed and the soft tissue has fully matured. This is important: patients should understand that "same-day teeth" means a high-quality temporary, not the permanent final result.