AbstractThe aim of this study was to evaluate immediate loading (IL) of dental implants in conjunction with grafting procedures. A total of 107 IL implants were inserted in six mini pigs. Before implant placement, crestal or apical defects were created, which were treated with bone chips, phycogene hydroxyapatite (HA), bovine HA, or bovine HA enhanced with a synthetic peptide. Crestal grafts were stabilized with titanium membranes. All bridges were in function and showed signs of chewing wear after 4‐month loading. Three out of 107 implants showed no osseointegration (2.7%). Most of the crestal defects showed incomplete regeneration, due to an infection of the membranes (74.3%) The difference in height between surgical and remaining defect was calculated as defect development, which was 2.3 ± 2.08 mm for bone chips with an area of regenerated bone of 22.8 ± 3.34% and 0.7 ± 2.22 mm for phycogene HA with 11.3 ± 4.36% regenerated bone. Bovine HA showed an increase of defects 1.3 ± 2.47 mm with only 7.9 ± 1.7% bone regeneration. Bovine HA enhanced with a peptide showed a defect development of 1.1 ± 1.42 mm with an area of regenerated bone of 18.2 ± 2.38%. In conclusion, local grafting procedures did not disturb the course of osseointegration for immediate loaded implants if primary stability was reached. The regeneration of apical defects was uneventful even with immediate loading. Crestal defects required membrane fixation with a careful flap elevation to avoid membrane exposure and loss of the graft. © 2009 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2009