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
What is the ideal site for an immediate?
- 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
- 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
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?
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
Early restored 6 weeks Type I-III and 12 weeks Type IV 1
- 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.