Immediate dental implant placement with extraction

immediate dental implant curved roots acteon piezotome

Immediate dental implant placement

Immediate dental implant survival rates about the same as those in mature bone.  No consensus on graft or membrane but primary closure preferred 1

Great article referencing Tarnows Chu and Salama  Dual Zone Technique

Immediate dental implant placement into a tooth with severly curved roots with the help of the acteon piezotome

What is the ideal site for an anterior immediate?

Some really want a screw retained crown for the anterior. However, only 62% of Jones 2022 JOI teeth have bone that allows that to be possible and it’s only 25% if ideal palatal form is the goal.

ITI says must have

  1. Intact socket walls
  2. 1mm facial bone
  3. Thick soft tissue
  4. No acute infection
  5. Bone apical and palatal for support

kan tooth bone position anteriorKan slide from ICOI meeting updated numbers from his 2011 study in JOMI

Extraction and immediate dental implant placement protocol

More steps for an anterior tooth are on our anterior tooth page.

  1. DO NOT FLAP!!! If have a fenestration can do an esthetic buccal flap.
  2. Atraumatic extraction. Something like the acteon piezotome is helpful for this.
  3. Debridement (removal PDL and any granulation tissue)
  4. Go to implant protocol (2mm from buccal plate)
  5. Follow 3×2 rule 
  6. Place lingually in socket and 3-5 from desired gingival facial height and/or 1-3mm below aveolar crest
  7. New Tarnow study showing steps soon to come out Dual Zone socket management
  8. Place cover screw and adjust bone around so temp abutment will sit nicely
  9. Temporize – Initial stability is crucial if plan to prov can achieve with length (3-5mm past apex), width (wider than socket), self-tapping or special design implant (1).
  10. Remove temp and graft buccal with cover screw in place (Use bovine for slower resorption)
  11. Replace temp and let it push graft out and seal area

Very nice if can place and leave a Zir abutment at time surgery and temporize.  Then just impression of Zir abutment later.  Great step by step of immediate implant placement with temp

For temp check here  Increases failure rate from about 5% to about 9% 

Immediate dental implant with provisional in an infected socket 1

  1. Pre (3 days) and post AB (7 days)
  2. Debride
  3. Irrigation with .12% CHX
  4. Avoid flap
  5. Maximize implant length and platform size to close gap (temp helps with this)
  6. <35Ncm=submerge
  7. >35Ncm prov
  8. Gap >2mm graft
  9. 3x3x3
  10. Perio health maintenance CHX bid x 7 days
  11. Check 24 hour, 1 week, 1 month, 1 year

Risk factors

  1. Chronic infection
  2. History apical surgery
  3. Loss of vestibular wall of aveolus
  4. Long time since vertical fracture (long standing chronic condition)

Bone graft the gap for immediate dental implant or not?

2mm is fine to leave according to many but I prefer to bone graft no matter what if can. Sanz 2017 COIR found less horizontal bone loss on grafted sites.

What about placing an immediate implant into a patient with chronic periodontal disease?

Ahmad 2024 EBD found no difference in placing immediate in these sites or waiting.

Dental Implant Loading Research

early loading dental implants loading implants

Many times in literature load really equals restoration=non-occusal load (especially in individual tooth)

Meta-analyis = Can load if 20 Ncm Benic 2014 IJOMI

Meta-analysis = No difference in immediate load and early load. Pigozzo JPD 2018

Immediate load if 25Ncm  Insertion torque correlated to success of immediate load

Immediate load (restored) ideal for anterior 97% but immediate placement and immediate restoration drops success rate 10%

Early restored 6 weeks Type I-III and 12 weeks Type IV 1

Loading protocols for implant supported and retained prosthesis

  1. Conventional load mand and max OD = good
  2. Early (no earlier than 48 hours, 1-6 weeks) load mand OD = good
  3. Early load max OD is more risky
  4. Immediate load mand OD = good but max OD = unknown
  5. Immediate load, early, and conventional all fine for fixed mand and max

Same study as above with perio patients 94% and then down all the way to 65% SO no immediate placement and immediate restore in perio patients!!

Success lower implants in fresh ext sites Lit Review EBD 2015 Khouly

Immediate non-occlusal implant loading vs. early non-occlusal implant loading  The null hypothesis of no difference in failure rates, complications, and bone level between implants that were loaded immediately or early at 3 years cannot be rejected in this randomized clinical trial.

Immediate restoration of delayed placement of implant in perio patient greater than 90%  (So slightly lower?)