The treatment of patients through the placement of immediate implants (IIP) has been a topic of discussion for a long time, and various authors have proposed different approaches in this direction.
This practice of immediate loading can be rewarding for both, the oral surgeons as well as the patients in many ways. Nevertheless, it is important to follow the strict guidelines for patient selection and the timing of implant placement while performing this technically challenging procedure.
The Swedish surgeon Branemark developed the concept of osseointegration during the 1960s . It refers to the biological adhesion between the implant body and the alveolar bone. Adequate bone support is required for the strong bond between the titanium body and the periodontal tissues; the latter affecting the implant stability.
There are three different approaches regarding the placement of implants :
Traditionally, after tooth extraction, the extraction socket was allowed to heal for four months and more. This technique was followed because it was believed that sufficient amount of time is necessary for the ossification and maturation of bone. Few authors developed the technique of placing the implant after one month of tooth extraction. However, this method can lead to the implant failure if the soft tissue healing is not sufficient as it can result in difficulty in securing the flap.
A study by Denissen HW-et al, proposed the need for immediate placement of implants as the delay of 3 months or more after the extraction of a tooth can result in excessive bone resorption . The advantages of immediate implant placement include:
- Reduced bone resorption
- Reduced surgical intervention and shortened duration of treatment
- Better esthetic results
- Increased bone-implant surface area as the width and height of the alveolar bone is preserved
To achieve the best outcomes, it is important to follow the strict protocols for patient selection for IIP. Usually, the cases with root resorption, endodontically infected tooth and root fractures are chosen for IIP . Nevertheless, it is crucial to follow the surgical criteria mentioned as follows:
- It is important to maintain the primary implant stability as the latter influences the process of osseointegration. Choosing an implant with a diameter greater than that of the extraction socket or extending 3-5mm beyond the apex usually ensures the primary stability.
- Proper debridement of the periapical lesion should be done as a chronic periapical infection is considered as a significant risk factor for implant failure. Also, some studies show that the success rate of IIP may be less in patients with periodontitis . So, before the implant placement, curettage of the inflamed and infected tissues should be done.
- The oral surgeon should try to make the extraction of the tooth atraumatic so that the integrity of the surrounding bone is preserved.
Thus the technique of immediate loading of an implant in the extraction site has its advantages. It is important to follow the strict patient selection criteria, proper workup and collection of anamnestic data, asepsis during the surgical treatment, preservation of the labial cortical plate and proper oral hygiene maintenance during the follow-up period for the success of immediate implants.
- Brånemark PI. Osseointegration and its experimental background. J Prosthet Dent. 1983 Sep. 50(3):399-410.
- Esposito M, Grusovin MG, Coulthard P, Worthington HV. The efficacy of vari-ous bone augmentation procedures for dental implants: a Cochrane systematic review of randomized controlled clinical trials. Int J Oral Maxillofac Implants. 2006;21:696–710.
- Denissen HW, Kalk W, Erdhis HA, Van Waas MA. Anatomic consideration for preventive implantation. Int J Oral Maxillofac Implants, 1993; 82: 191-196.
- Schwartz-Arad D, Chaushu G. The ways and wherefores of immediate placement of implants into fresh extraction sites: a literature review. J Periodontol, 1997; 68: 915-923.
- Novaes AB Jr, Novaes AB. Immediate implants placed into infected sites: A clinical report. Int J Oral Maxillofac Implants, 1995; 10: 609-613.