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Authors: Dr. Manesh Lahori, Dr. Garima Virmani
 

Due to the success with osseointegrated implants, treatment consisting of extraction and replacement by endosseous implants. Treatment modalities in dentistry changed markedly when osseointegration became the basis for a predictable outcome of oral implant treatment.



IMPLANTATION

Placement of the implant based on the morphological, dimensional, and histologic changes following tooth extraction and on common practice derived from clinical experience.

  • Immediate
  • Delayed
  • Late

Immediate implantation: The implant is placed immediately after the tooth extraction, and the bioesthetic healing abutment is screwed in simultaneously or the machined abutment is screwed in and non functional temporary crown is placed .

Delayed implantation: The insertion of an implant in an area in which connective tissue and epithelium have closed over the alveolus, but the underlying bone has not yet regenerated to fill the alveolus.

Late implantation: Implantation in an edentulous area where epithelium and connective tissue and bone are completely healed usually at 6 months following tooth loss.

Ideal scenario for an immediate implant placement involves:
  • an atraumatic extraction
  • stabilization of the implant within the confines of prepared
  • extraction socket so that it has maximal contact with the
  • freshly prepared bone.
  • Placement of implant in proper angulation
  • Primary closure of the surgical flap
  • Uneventful healing
  • Final restoration of the implant with a functional prosthesis
GUIDELINES FOR CASE SELECTION
INDICATIONS:
  • Traumatic loss of teeth
  • Grossly decayed tooth without the presence of purulent exudates or cellulites.
  • Incomplete endodontic procedure.
  • Over-retained primary teeth.
CONTRA INDICATIONS
  • Purulent exudates
  • Soft tissue cellulites and granulation tissue
  • Inadequate bone apical to the extraction site
  • Anatomic configuration of remaining bone
  • Clinical condition that prevents primary wound closure
  • Poor interest and cooperation from the patient
ADVANTAGES
  • Reduced number of surgical procedures
  • Preservation of alveolar bone
  • Shorter treatment time
  • Better osseointegration
  • Optimal esthetics
  • Reduced cost
DISADVANTAGE
  • Will present a defect of upto 2mm corono apically.
Guidelines for extraction when planning for immediate implant placement
  1. Preoperative evaluation
  2. Antibiotic therapy initiation
  3. Preservation of the bony receptor site
  4. Procedural delays
  5. Use of periotomes/luxators
  6. Avoidance of excessive pressure
  7. Osteotomy preparation
  8. Improvements for placement
  9. Bone grafts
  10. Soft tissues closure
  11. Successful osseointegration
  12. Implant loading
  13. Use of an Easy X-Trac System(Implant dentistry, volume 16,number2,139-145)
DIAGNOSIS

As with all implant treatment, good initial diagnosis and treatment planning is essential. According to Kois, five diagnostic keys exist for single tooth peri-implant esthetics when an immediate extraction and implant insertion is contemplated:

  1. Tooth position relative to free gingival margin
  2. Form of periodontium
  3. Biotype of periodontium
  4. Tooth shape
  5. Position of the osseous crest before extraction
TAPERED IMPLANTS

Although excellent results can be obtained when placing standard implants in fresh extraction sites, tapered, anatomically shaped implants are the implant of choice for this indication instead of having a uniform diameter, Such implants more closely mimic the shape of natural tooth roots. They are wider at the cervix than at the apex.

Tapered implants are available in these surfaces:

  1. Acid etched titanium
  2. Hydroxyapatite coated
  3. TPS coated
CONCLUSION

One of the main limitations of today’s implant dentistry is the amount of residual alveolar bone. With the introduction of immediate implantation this limitation has been overcome.

Successful immediate placement of an implant at the time of tooth extraction relies on excellent soft and hard tissue quality and quantity.

As it utilizes the bone surrounding the tooth to be extracted and also reduces the time interval it circumvents, the time taken for healing of the extracted socket before placing the implant thus effectively reducing the time from extraction to the insertion of restoration

CASE PRESENTATION
 
CASE PRESENTATION 1
1: Preoperative place photograph 2: preoperative radiograph
 
3: extracted tooth 4: implant in (5x12mm)
 
5:Post operative coping Radiograph 6:After healing phase
 
7: implant abutment with transfer
 
8: Prepared Abutment 9: final prosthesis
 
10: post restoration radiograph
 
CASE PRESENTATION 2
 
1: Preoperative
 
2: Extracted teeth
 
3: Implants at Insertion
 
4: Final restoration
 
5: Restoration in place

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