Ever heard opposing views on immediate implant placement? Some say it’s risky, while others say it’s just as good or even better than delayed implants. Here ARIA will demystify some of your confusion.
Immediate implants are those placed immediately after tooth extraction and as part of the same procedure (Hämmerle et al., 2004). Traditionally, it was believed that after a tooth is extracted, the socket should fully heal for 4-6 months before an implant is placed. Nowadays, newer research shows that immediate implants can be just as or even more successful than delayed implants given the right circumstances. Reduced bone necrosis and increased bone remodelling both reduce crestal bone loss and surgical trauma (Ebenezer et al., 2015). This may in turn also preserve soft tissue aesthetics. .
There are, of course, prerequisites to such treatment. Our Melbourne and Adelaide implant courses cover these extensively, however, here is a brief overview.
Results are best when
- The buccal and lingual plates of the extraction socket are present
- Teeth adjacent to the socket are free from overhangs and insufficient restoration margins
- The interradicular septum is wide and intact after tooth extraction (Chen et al., 2004; Ebenezer et al., 2015).
Immediate Implant Stability
For long term implant success, one of the most important factors is its primary stability once inserted. This may be through placing the implant 3-5mm apically into the bone, or choosing an implant with a wider diameter than the socket (Koh, Rudek, & Wang, 2010). The implant, however, should not necessarily be angulated according to the extraction socket, as this may cause the need for an angulated abutment, leading to additional stress to the implant crown (Koh et al., 2010). This in turn may cause bone loss or even implant failure. Guiding the implant to the correct position, as covered in our Master Implant Courses, is integral to providing a fixed prosthetic that can support your patient’s oral functions.
Soft tissue health is also ideal to obtain primary wound closure. This may reduce healing complications and scarring.
Any signs of local infections such as purulence, granulation tissue or cellulitis may, on the other hand, act as contraindications to treatment. These should be managed first (Chen et al., 2004; Ebenezer et al., 2015). Inadequate bone apical to the socket, or adversely located neurovascular bundles, maxillary sinus or nasal cavities may also prevent immediate implant placement. Bone remodelling and wound healing is also less optimal in the presence of thin tissue biotype, lack of soft tissue closure over the extraction socket, and absence of keratinised tissue(Ebenezer et al., 2015). Such circumstances are best for delayed implant placement, and may indicate the need for bone augmentation.
Our specialist prosthodontists and periodontists can help guide your treatment plan and decide if immediate implant placement is possible for your patient.
Chen, S. T., Wilson, J. T. G., & Hämmerle, C. H. F. (2004). Immediate or early placement of implants following tooth extraction: review of biologic basis, clinical procedures, and outcomes. Int J Oral Maxillofac Implants, 19 Suppl, 12-25.
Ebenezer, V., Balakrishnan, K., Asir, R. V. D., & Sragunar, B. (2015). Immediate placement of endosseous implants into the extraction sockets. J Pharm Bioallied Sci, 7(Suppl 1), S234-S237. doi:10.4103/0975-7406.155926
Hämmerle, C. H. F., Chen, S. T., & Wilson, J. T. G. (2004). Consensus statements and recommended clinical procedures regarding the placement of implants in extraction sockets. Int J Oral Maxillofac Implants, 19 Suppl, 26-28.
Koh, R. U., Rudek, I., & Wang, H.-L. (2010). Immediate implant placement: positives and negatives. Implant Dent, 19(2), 98-108. doi:10.1097/ID.0b013e3181d47eaf