Ten patients with a mean age at implant insertion of 64 ± 11.3 years (range 38 to 81 years; six women, four men) were included. Sixty titanium screw implants (Table 1) were inserted and immediately loaded between 09/2009 and 01/2013.

Seven patients had remaining teeth until implant surgery (two patients with 4, four patients with 7, and one patient with 12 teeth). Twenty-one (35%) of the 60 immediately loaded implants where inserted in fresh extraction sockets. Six implants in each patient were splinted by the provisional prosthesis on the day of surgery. The opposing dentition was natural teeth (n = 4 patients), implant-supported fixed prostheses (n = 4 patients), or natural teeth combined with additional implants (n = 2 patients). All patients analyzed showed at least opposite dentition with at least the first molar of the mandible replaced on both sides.

Three of 60 immediately loaded implants (5%) in three patients were not osseointegrated after first removal of the temporary restorations 3 months after surgery (1 implant among the 40 axial implants [2.5%] and 2 implants among the 20 tilted implants [10%]).

The lost axial implant (12 × 4 mm, ISQ 68, PT value −2) was inserted in a fresh extraction socket in the patient with the most remaining teeth before implant surgery. In this patient, the temporary restoration broke two times.

The two non-osseointegrated tilted implants were both 14 × 4 mm. One was inserted in a maxilla which was edentulous for several years (ISQ 68, PT value −4). The other tilted implant was inserted in a maxilla with seven remaining teeth (ISQ of 49 and a PT value of +1). This implant was located with its apical half in the extraction socket of an immediately extracted canine. All failed implants were immediately replaced with implants of a larger diameter or length. All replaced implants healed load free and transmucosal. In both cases of the two non-osseointegrated tilted implants, the provisional prostheses were shortened but a cantilever extension of one molar width was left since the other implants were osseointegrated at this time. The final prosthesis procedure for the three patients with initial failures started 6 months after the first implant insertion, but the patients were functionally restored with a fixed prosthesis over the entire time.