Clinical
implant placement Immediate
Placing an implant into a fresh extraction socket is less invasive for patients and gives excellent results, reports Dr Tariq Ali
A
s dentists, we find ourselves in an exciting era of thera- peutic change with the availability of
dental implants. This brings with it a number of challenges and, as our patients become more aware of their implant options, there is a desire to expedite treatment with the minimum number of surgical procedures. This article discusses the rationale
and clinical stages of immediate implant placement. Immediate implant placement
can be defined as implant place- ment into a fresh extraction socket. It is now a well-accepted technique. Gomez-Roman et alı demonstrated a 97 per cent implant success rate that is comparable with the more conventional delayed approach. The technique is less invasive than a delayed approach, while main- taining bone and reducing overall treatment time. A 29-year-old woman was referred
by her dentist for implant treatment to replace a failing retained decid- uous tooth (LLE – Figures ı and 2). The patient’s main concern was that she was moving abroad and wished
treatment to be completed within four months. Medically, the patient was fit and healthy, a non-smoker with no parafunctional habits. Careful assessment was carried
out with appropriate radiographs, CT scanning and diagnostic wax ups. CT scanning (Figures 3 and 4) provides valuable information in cases like this, showing the ridge morphology, amount of available bone, root morphology and posi- tion of any anatomical structures such as the IAC.
Rationale and treatment plan The patient was presented with the various options to replace the failing tooth and she decided on an implant. From the information available, an immediate implant and restoration were indicated. The favourable indications for immediate implant placement and restoration in this case are: • short roots and adequate bone volume • no parafunctional habits and therefore excessive load on the osseointegrating implant • adequate keratinised tissue as the gingival biotype can be difficult to control
• no pathology. It is certainly possible to place implants in sockets with chronic periapical pathology2. However, careful debridement is required. Immediate placement is contraindicated in areas of acute infection • meets patient’s expectations and timeframe. By using a transitional resto-
ration at the time of implant placement (immediate restora- tion), the soft tissues can be contoured, so developing the emergence profile for the final crown. An added benefit of imme- diate loading is the maintenance of bone levels around the implant3. Immediate loading is only possible
in the presence of primary stability and it is important to the treatment plan in case this is not achieved. If primary stability is not achieved, then the immediate loading must be abandoned. The wound can be closed with a vascularised pedicle flap or free gingival graft. A healing abutment can be used which is of sufficient height and width to fill the wound. However, it is necessary to ensure
that the patient does not place any force on this abutment. It is possible
Fig 1 Failing LLE
Fig 2 PA failing LLE
Fig 3 CT scan showing bone profile
54 Scottish Dental magazine
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