Immediate Loading in oral implantology requires safe cortical anchorage of the load transmitting surfaces of the implants, because even the most miraculous surface properties of dental implants alone will never lead to the possibility of immediate loading. This article describes a new didactic approach for communicating the principles of this technology. The terminology which we propose should be used both for the purpose of denominating corticals suitable for load transmission and points of occlusion and slopes of mastication with respect to the positioning of the mentioned load transmitting areas. We propose to use the “1-2-3 classification” for the identification of the 1st, 2nd and 3rd cortical as points of interest for positioning of the abutment (at 1st cortical) and for remote initial osseofixation (2nd or 3rd cortical) for axial basal implants in oral and maxillofacial implantology. Furthermore, we propose to use the term “Supporting Polygon” to determine the position of occlusal contacts or masticatory slopes within or outside of a polygon drawn up by the load transmitting parts of the implants in the “2nd-“ or “3rd cortical”. The most significant locations at the polygon are implants on the corners or ends of it, i.e. implants in the area of the canines and the 2nd molars in both jaws. Today we name these position “strategic positions”. If these positions are not equipped properly with implants, or if one or more of the implants in the strategic position is not anchored well in the 2nd and/or 3rd cortical the whole case is prone to failure. Since this treatment concept completely disregards the “1st cortical” or spongious bone for the purpose of load transmission, it is suitable for axial basal implants (i.e. the concept of strategic implantology) and lateral basal implants.
In traditional dental implantology there are numerous classifications available, which consider the height of the available bone and width of the alveolar ridge. Those classifications usually include the crestal (i.e. oral) cortical, the opposing cortical bone in the upper jaw and the spongious bone if present, and inform us about the limitations of implant placement by directing landmarks or guiding reconstructive procedures. The floor of the nose cavity, the sinus in the maxilla or the mandibular canal in the distal mandible, are examples of limiting landmarks. Moreover, according to crestal implant concepts, the crestal bone should be wide enough to hold the vertical implant part in full. In basal implantology such a demand does not exist, because only the presence of the 2nd cortical is required for implant anchorage and because vertical parts of the implants may run outside of the alveolar bone for almost all of the implant length, as long as the thread is anchored in the 1st and 2nd cortical (Figure. 8). Therefore, cases with reduced alveolar bone dimensions (cases providing significant atrophy) are considered in strategic implantology not as difficult, as long as the 2nd cortical is available. We assume today that atrophied cases provide even higher chances of success, because macro-trajectorial forces through the bone, within the skeleton are (a) larger in relationship to the bone mass and hence stimulate the available bone towards developing or maintaining a higher degree of mineralization, and because (b) these forces per se prevent any further atrophy.