Immediate Implants

Immediate Implants

We all strive to ensure that we maintain good physical health. We also invest a good amount of time in maintaining good oral health. Yet, many face damages to their teeth due to various reasons, natural or induced. However, the dentists have worked relentlessly and continue to do so to give the best possible solution to these patients by restoring their natural smile at their best.

Traditionally, missing teeth and supporting oral tissues were replaced with dentures or bridges, thus restoring the oral functions of chewing, speech as well as for aesthetics. The advent of dental implants revamped the complete approach to solving these issues. They delivered much better natural-looking and functional oral health compared to earlier solutions.

Until recently, after the infected teeth were removed the extraction sockets were left to heal for a period varying from several months to a year. The complete process would take several sessions and span for more than 1 year. This prolonged process has often had a psychological impact on patients.

In the 1990s, a new revolution was brought about with the introduction of the Immediate Implants procedure. In this procedure, the implants are placed in the extraction sockets immediately after the compromised teeth are extracted. In most cases, this is done in the same session as the teeth are being extracted. This was widely accepted by patients as it shortened the period of treatment considerably.

The implants can be placed in

  • Fresh extraction sockets
  • Infected sockets
  • Periapical infected sites, etc.

At DENTX, each patient is meticulously evaluated on several parameters before they are deemed eligible for the Immediate Implants procedure. A few of the initial investigations were carried out to test the eligibility areas listed below.

  • Thorough medical and dental histories
  • Habits like smoking
  • Clinical photographs
  • Casts are studied
  • Periapical or panoramic radiographs
  • Linear or Computerised Tomography of the proposed implant sites
  • Reason for extraction of the teeth
  • Periapical pathology

Additional investigation is conducted depending on the individual case, as deemed fit. The findings are thoroughly analyzed before a patient is considered as an eligible candidate for Immediate Implant.

Some of the criteria considered for deciding on the eligibility are

  • Primary stability and Bone quality and Bone quantity to ensure the ability to achieve predictable Osseointegration
  • The extraction site morphology and the surrounding anatomy to ensure the anatomy of the site is suitable
  • Ability to maximize aesthetic results and maintain soft tissue
  • The surgical procedure/technique
  • Presence of infection
  • Selection of the implant component

In this decision process, most dentists follow The Rule of 5 Triangles to achieve excellence when placing Immediate Implantsand thus prevent blunders that could lead to unwanted esthetic situations.

  • The presence of a buccal plate
  • Primary stability
  • Implant design
  • Filling the gap between the buccal plate and the implant
  • Tissue biotype.

Tooth Extraction and Immediate Implant Placement Procedure

Under anesthesia, one of the various flap techniques is used to gain access for tooth extraction and thus the tooth is extracted atraumatically. The expert dentists at DENTXwill then choose 1 of the following most minimally invasive techniques to extract the tooth/teeth.

  • Button Sewing Technique
  • Wiggle and Wait Technique
  • The Modified Elevator Technique

An atraumatic extraction is carried out to ensure there is no pronouncedbone loss. While positioning the implant in a suitable 3D position, the void is grafted with biomaterial. It is suggested to compensate soft tissue, by means that of overbuilding buccal with biomaterial or by a soft tissue graft. Provisional crowns will be used in this procedure to take care of soft tissue contours. Implant design is recommended to be self-tapering, thus ensuring that it reaches primary stability.

Proceeding to the actual placement of implants, the dentist will select one of the following methods

  • Socket Preservation
  • Socket Shield Technique
  • Dual Zone Technique
  • Flapless Approach

Top of Form

Bottom of Form

Socket Preservation Technique

The Socket Preservation Technique involves atraumatic extraction which is immediately followed by grafting of the extraction sockets by using particulate bone graft materials, which can be done with or without membranes. This technique has shown promising results with the least alveolar ridge dimensional changes post-extraction while simultaneously preserving alveolar hard and soft tissues.

This technique is preferred for immediate implant placement when intact or nearly intact extraction sockets are seen thus reducing the time required to achieve a final restoration.

Though socket preservation techniques are beneficial and highly recommended, soft tissue closure and graft containment are the difficulties encountered during the procedure.

Socket Shield Technique

Socket Shield Technique is a very efficient method that ensures minimal invasion and tissue preservation, along with avoiding the need of bone substitute materials. While replacing a failing tooth, the ridge shape is maintained by using this technique combined with immediate implant placement. This technique ensures that the healthy peri-implant soft tissue is maintained as well as the good functioning of the implant-supported prosthesis.

Dual Zone Technique

In the Dual Zone Technique, the area under consideration is divided into two regions which are the tissue zone and bone zone. Commonly, the contour of the ridge can change post tooth removal, and after undergoing implant placement, bone grafting, and provisional restoration. The dual-zone technique minimizes the change in contour which is associated with immediate implants, mainly in the anterior region. With this technique, the excess cement around the final crown can be indirectly removed and thus avoiding peri-implantitis, which is generally caused due to residual cement left in the implant gingival sulcus.

Flapless Approach

This approach is minimally invasive and ensures the interdental papilla is intact which ensures the least disruption of blood supply during extraction with socket grafting or during the immediate implant placement. The Flapless Approach projects greater potential for soft tissue volume maintenance. Additionally, dense PTFE membrane is used which improves the resultant outcome of the immediate implant placement while eliminating the necessity of primary closure and the leading damage to soft tissue architecture.

Advantages

  • Patient acceptability
  • No additional pre-implant surgery
  • No waiting for healing of the socket
  • Reduced treatment time and the transitional period
  • The implant can be positioned more favorably than the original position
  • Facilitates final restoration and minimizes the need for severely angled abutments
  • Implants in the extraction sites can be placed in the same position as the extracted teeth
  • Soft tissue profile is maintained
  • Bone loss is prevented

Disadvantages

  • It is a technically more demanding procedure
  • Lack of control on final implant position
  • Difficulty in obtaining primary stability
  • It requires extensive soft tissue manipulation
  • Site morphology may complicate optimal implant placement
  • Thin tissue biotype may compromise optimal outcome
  • The added cost of bone grafting
  • Increased possibility of infection post-implantation as the membrane exposure is high
  • Diabetic patients and heavy smokers are at higher risk of not having dental implants properly heal and attach in the mouth.

Conclusion

Immediate implant placement following tooth extraction has been widely accepted by the dentist as well as the patients as a promising solution for tooth loss. The minimally invasive surgical technique, reduced treatment time, and transitional period along with almost non-existent post-extraction complications, preservation of gingival aesthetics are the reasons for its popularity. However, like all medical procedures, case selection, diagnosis, and treatment planning are to be followed cautiously by the dentists. Meanwhile, meticulous post-operative care is to be ensured by the for the long term success of the immediate implants.

 

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