Immediate implant placement extraction

Immediate placement dental implant

Survival rate about the same as those in mature bone.  No consensus on graft or membrane but primary closure preferred 1

Max Dental implant for molar site
Great article referencing Tarnows Chu and Salama  Dual Zone Technique

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

  1. DO NOT FLAP!!!
  2. Atraumatic extraction
  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

Buccal fenestration use aesthetic buccal flap (ABF)

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 implant with prov in infected socket 1 2

  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 graft no matter what if can. Sanz 2017 COIR found less horizontal bone loss on grafted sites.

 

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

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
  5. Immediate load max OD = unknown
  6. Immediate load, early, and conventional all fine for fixed mand and max

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?)

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

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

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