Implant Research

INTRODUCTION: Placement of implants immediately following extraction has now become
an increasingly common strategy to preserve bone and reduce treatment time.On one hand, it
shortens treatment time and can improve esthetics because the soft tissue envelope is
preserved.
Immediate implant
DIAGNOSIS AND TREATMENT PLANNING: For the long term success of immediate
implants, an appropriate diagnosis and treatment plan is to essential .When evaluating a
patient for dental implants, thorough medical and dental histories,clinical photographs,study
casts,periapical and panoram radiographs as well as linear tomography or computerised
tomography of the proposed implant sites should be considered.The most important step in
treatment planning is determining the prognosis of the dentition,and in particular the prognosis
of the tooth in question .Crown to root ratio,remaining root length,periodontal attachment
level,periodontal attachment level,furcation involvement,periodontal health status of teeth
adjacent to the proposed implant site,non restorable caries lesions,root fractures with large
endodontic posts etc., should be evaluated.Implants to replace teeth with non vital
pulp,fractured at the gingival margin with roots shorter than 13 mm,is often considered as the
treatment of choice.
Indications
Immediate implantation is indicated in the cases of teeth
compromised by dental trauma, root fractures/root fissures,
endodontic complications, root resorptions. It is limited to sites with
3 or 4 alveolar walls with a minimum of circumferential defect. Most
authors recommend the presence of at least 3 to 5 mm of residual
bone beyond the apex and a minimum bone height of 10mm for
primary implant stability .
Advantages :
Patient psychological advantages.
Technical advantages: Bone of fresh extraction socket is
dense, ridge shape is similar to the dental arch, reduced treatment
duration, some additional techniques such as sinus lift or grafting
could be avoided in some situations, soft tissue preservation by
maintaining the inter-dental papilla.
Disadvantages :
Risk of partial resorption of alveolar wall (s) due to a
pathologic process or to a traumatic damage during the extraction.
Augmentation of the risk of infectious complications and
failures.
Difficulty to achieve a primary stability.
Gap between implant surface and socket wall
Additional cost in cases of combined guided bone
regeneration
Difficulty to predict the final position of the implant (case
of multirooted teeth).
Difficulty to achieve a complete closure of the implant site.
Need to raise a flap in order to cover the implant if 2 stageprocedures
is preferred.
The implant survival rate of immediate implantation is 96-100%
. It could be considered as a predictable and reliable procedure.
Immediate implant
SOFT TISSUE MANAGEMENT FOR IMMEDIATE IMPLANTS:
SOCKET SHIELD TECHNIQUE:
Socket shield technique is a method which meets the demands of minimal invasion, tissue
preservation, and no need of bone substitute materials. The application of socket shield
technique combined with immediate implant placement for replacing a failing tooth will
maintain the ridge shape. The implant-supported prosthesis will function well and healthy peri-
implant soft tissue is maintained
SOCKET SHIELD TECHNIQUE

IMMEDIATE IMPLANT PLACEMENT USING FLAPLESS APPROACH: The flapless
technique provides a minimally invasive approach to extraction with socket grafting or
immediate implant placement. Because the interdental papilla remains intact, there is less
disruption of blood supply. As a result, there is a greater potential for maintenance of soft
tissue volume. In addition, the use of a dense PTFE membrane improves the predictability of
immediate implant placement, excluding the requirement for primary closure and resultant
disruption of soft tissue architecture
Tooth extraction and implant placement procedures
Various surgical flap procedures can be used to gain access for tooth extraction (4). Figure 1(A–L)
represents the authors routine surgical sequence for placement of a single immediate implant in the
esthetic zone using a minimally invasive surgical method. Infection may be present, as evidenced by the
suppuration exuding from the palatal aspects. Many clinicians postpone treatment of sites exhibiting
infection. Novaes et al. (63) and Villa & Rangert (86) recently reported on a case series of patients where
implants were installed immediately after extraction, and where the extracted teeth exhibited signs of
periodontal or endodontic infections. At 2 years post-treatment, the cumulative survival rate was 100%.
This study indicated no adverse consequences for an implanted site after extracting an infected tooth.
Teeth to be removed and implants placed immediately after extraction can be accessed using either
open flap surgery or a minimally invasive surgical technique. With experience the surgeon can displace
the marginal tissues buccal–lingually to gain access to the surgical site. A Molt C2 curette (HiFriedy,
Chicago, IL) is useful to luxate the root mesial–distally. To avoid damaging the buccal plate, care must be
exercised not to luxate buccal–lingually. After tooth removal, a curette is used to confirm that the
location of the buccal plate is intact. The surgical guide is placed over the surgical site and a sharp
precision drill (Nobel Biocare, Yorba Linda, CA) (Fig. 2) is used to penetrate the palatal wall of the
extraction socket. This drill guides the initial preparation of an osteotomy. In the maxillary anterior
region it is important to avoid placing the implant directly into the extraction socket. Otherwise, the
implant will invariably perforate the buccal plate and jeopardize implant survival. The axis of the implant
must correspond to the incisal edges of the adjacent teeth or be slightly palatal to this landmark. A
direction indictor should be used to verify the correct angulation and trajectory of the proposed implant
(Fig. 1G). Standard drilling procedures are performed according to the manufacturers instructions. In the
esthetic zone, the implant head should be a minimum of 3 mm apical to an imaginary line connecting
the cemento–enamel junctions of the adjacent teeth and apical to the interproximal and crestal bone
(43). This will assure a proper implant emergence profile and facilitate proper implant restoration. The
stability of the implant can be verified using resonance frequency analysis (13). The torque registered on
the drilling consul can also be a good indicator of initial implant stability. Torque resistance of 40
Newton centimeters is indicative of osseointegration has been confirmed (maxillary anterior region 4–6
months) (Fig. 1K,L). In the event that an immediately placed implant encroaches upon the maxillary
sinus, it might be prudent to postpone implant placement, augment the sinus, allow for bone healing,
and than place the implant.

Implant Research

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Implant Research

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INTRODUCTION: Placement of implants immediately following extraction has now become

SOFT TISSUE MANAGEMENT FOR IMMEDIATE IMPLANTS:

SOCKET SHIELD TECHNIQUE:

SOCKET SHIELD TECHNIQUE

Tooth extraction and implant placement procedures

and than place the implant.

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