Immediate dental implant placement with extraction
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
What is the ideal site for an 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.
- Intact socket walls
- 1mm facial bone
- Thick soft tissue
- No acute infection
- Bone apical and palatal for support
Kan 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.
- DO NOT FLAP!!! If have a fenestration can do an esthetic buccal flap.
- Atraumatic extraction. Something like the acteon piezotome is helpful for this.
- Debridement (removal PDL and any granulation tissue)
- Go to implant protocol (2mm from buccal plate)
- Follow 3×2 rule
- Place lingually in socket and 3-5 from desired gingival facial height and/or 1-3mm below aveolar crest
- New Tarnow study showing steps soon to come out Dual Zone socket management
- Place cover screw and adjust bone around so temp abutment will sit nicely
- 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).
- Remove temp and graft buccal with cover screw in place (Use bovine for slower resorption)
- 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
- Pre (3 days) and post AB (7 days)
- Irrigation with .12% CHX
- Avoid flap
- Maximize implant length and platform size to close gap (temp helps with this)
- >35Ncm prov
- Gap >2mm graft
- Perio health maintenance CHX bid x 7 days
- Check 24 hour, 1 week, 1 month, 1 year
- Chronic infection
- History apical surgery
- Loss of vestibular wall of aveolus
- 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.
Dental Implant Loading Research
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
- Conventional load mand and max OD = good
- Early (no earlier than 48 hours, 1-6 weeks) load mand OD = good
- Early load max OD is more risky
- Immediate load mand OD = good but max OD = unknown
- 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?)
Wow, very insightful, nice collection of your data.. very helpful