IMMEDIATE IMPLANT PLACEMENT : POSITIVES & NEGATIVES - Dr. Stephen DDS, Sandeep DDS, Dr. Vikas Gowd MDS
Ever since, Branemark in 1952 discovered that osseointegration can occur between titanium implants and tested pure titanium fixtures, known as dental implants. He termed it osseointegration and defined it as a “direct structural and functional connection between ordered, living bone, and the surface of an implant under light microscope.” Branemark’s original protocol for dental implant placement was 6 to 8 months healing postextraction; sterile conditions using a mucobuccal flap and placing machined titanium implants in a 2-stage approach; 3 to 6 months stress-free healing period for temporary removable prosthesis
for an extended amount of time.
Other concerns with using a 2-stage approach, such as Branemark’s protocol, include: volume loss of alveolar bone, increased time, edentulism, longer treatment time, additional surgical procedure, and psychological impact on the patient. After tooth extraction, the alveolar ridge undergoes bone remodeling, especially within the first year. One study reported that an overall decrease of 4.0mm in ridge height and 25% loss of total bone volume occurred within 1 year postextraction. This same study reported that the volume of bone lost increased 40% to 60% in 3 years.
IMMEDIATE IMPLANT PLACEMENT INDICATIONS AND CONTRA INDICATIONS
Critical evaluation of smile line, bone and gingival architecture, and hard and soft tissue levels are essential for implant esthetics. diagnostic factors for predictable single tooth peri- implant estetics when immediately placing implants in extraction sockets. They are (1) tooth position relative to the free gingival margin, (2) form of the periodontium, (3) biotype of the periodontium, (4) tooth shape, and (5) position of the osseous crest before tooth extraction. Three of the 5 factors is critical
Fordeterminig if the patient has the right diagnostic factors to allow for predictable success. Surgical approach for an immediate implant approach is almost similar to the delayed approach except the immediate implant placement a consideration if implant shift to the buccal side should be taken into consideration. Thia is due to thin buccal plate with high content of bundle bone as well the nature of self tapping implants that we used these days.
Thick biotype is resilient and prone to pocket formation whereas thin biotype is more prone to gingival recession after mechanical or surgical manipulation. A sufficient amount of crest ridge with width of 4 to 5 mm and high of 10 mm or more minimal requirements for predictable immediate implant placement the high is necessary for a stable implant and marinating a safety distance from vital anatomical structures (mandibular canal, maxillary sinus, or nasal floor).A diatnce of < 5mm from alvealor crest to the future prosthesis contact point can ensure the appearance of dental implant papillae. In regards to immediate approach.the ideal extraction socket would present little or no periodontal bone loss.
Currently it is a great that implants can be successfully placed at the time of extraction. in peri apical lesion site as long as the infection is removed and an implant primary stability is achieved .the indications and absolute and relative contraindications for immediate implant placement. Funato et al created a classification indicating or limiting immediate placement baased on the characteristics of bucccal bone and soft tissue profile.this 4-class classification provided the guidelines for immediate implant placement and timing between extraction and implant placement.class I has intact buccal bone with thick biotype and indicated to have optimal results with immediate placemant without flap reflection.class II has intact buccal bone with thin biotype and indicated to have good results with immediate placement with a connective tissue graft procedure. classIII has deficient buccal within the alvealor housing and indicated to have limited and acceptable result with immediate placement
with a guided bone regeneration plus connective tissue graft.class IV has deficient buccal bone deviating and unacceptable for immediate placement,delayed approach is recommended. This classificationb system supports the idea.the case selection is important for determining whether immediate impant placement should be considered and that hard and soft tissue parameters are important in this selection,
Generally it is considered that immediate implant placement can be challenging due to unpredictable hard and soft tissue healing.carefullt case selection is necessary to avoid treatment failures and esthetics complitations. hence, discussing the risks, benefits, limitations of immediate implant placement to avoid any future misunderstanding.
The immediate implant placement approach has been studied since the 1970s.evidence available today indicated that it is a successful procedure that may offer certain benefit to patients. However, careful planning and case selection are needed to ensure implant success as well as final esthetic outcomes.