Extraction and Immediate Placement of Implant. Introduction The dental implants revolutionized the practice of dentistry and have become a successful,

Extraction and Immediate Extraction and Immediate Placement of ImplantPlacement of Implant

IntroductionIntroduction

The dental implants revolutionized the The dental implants revolutionized the practice of dentistry and have become a practice of dentistry and have become a successful, predictable treatment modality successful, predictable treatment modality in partially and fully edentulous patients in partially and fully edentulous patients

A healing period (6-12 months) after A healing period (6-12 months) after extraction was considered one of the most extraction was considered one of the most important factors for success of dental important factors for success of dental implants implants

IntroductionIntroduction

Several studies clearly demonstrated the Several studies clearly demonstrated the progressive alveolar bone atrophy progressive alveolar bone atrophy occurring after loss of teeth in all directions occurring after loss of teeth in all directions

The residual alveolar ridge might be The residual alveolar ridge might be inadequate to insert dental implants inadequate to insert dental implants

The insertion of dental implants into fresh The insertion of dental implants into fresh extraction sites provided a realistic extraction sites provided a realistic solution to overcome this problem solution to overcome this problem

IntroductionIntroduction

The most obvious advantages of The most obvious advantages of immediate dental implants are bone immediate dental implants are bone preservation and reduction of treatment preservation and reduction of treatment time with relevant patients’ satisfaction time with relevant patients’ satisfaction

IntroductionIntroduction

Immediate implant placementImmediate implant placement

Delayed implant placementDelayed implant placement

Staged implant placementStaged implant placement

DefinitionDefinition

ImmediateImmediate implant placement occurs at implant placement occurs at the time of extractionthe time of extractionDelayedDelayed implant placement is performed implant placement is performed approximately 2 months post-extraction to approximately 2 months post-extraction to allow soft tissue healingallow soft tissue healingStagedStaged implant placement allows for implant placement allows for substantial bone healing within the substantial bone healing within the extraction site that typically requires 4-6 extraction site that typically requires 4-6 months or longermonths or longer

Success rate 90-95%Success rate 90-95%

Success rate 93.9% (Becker 1994)Success rate 93.9% (Becker 1994)

AdvantagesAdvantages

Treatment time is reduced Treatment time is reduced Width and height of alveolar bone is Width and height of alveolar bone is preserved preserved Enables the operator to achieve ideal Enables the operator to achieve ideal implant location mesiodistally and bucco-implant location mesiodistally and bucco-lingually lingually Crown length is in harmony with the Crown length is in harmony with the adjacent teeth, natural scalloping and adjacent teeth, natural scalloping and distinct papillae are easier to be achieved distinct papillae are easier to be achieved

DisadvantagesDisadvantages

Unfavorable implant angulation due to Unfavorable implant angulation due to misalignment of the extracted toothmisalignment of the extracted tooth

Failure to achieve the critical element of Failure to achieve the critical element of primary stability due to anatomical primary stability due to anatomical considerations considerations

Inability to perform primary closure Inability to perform primary closure

IndicationsIndications

Root fractureRoot fracture

Crown fractureCrown fracture

Endodontic failureEndodontic failure

Severe decaySevere decay

Unfavorable crown-root ratioUnfavorable crown-root ratio

ContraindicationsContraindications

Infected site (presence of purulent Infected site (presence of purulent exudate)exudate)

Insufficient depth for primary stability of Insufficient depth for primary stability of the fixturethe fixture

Width of the extraction socket is less than Width of the extraction socket is less than 4-5 mm4-5 mm

Ideal extracted sites are:Ideal extracted sites are:1.1. 4 wall socket4 wall socket

2.2. 3 wall dehiscence type defect (5 mm or less) 3 wall dehiscence type defect (5 mm or less) in apico-coronal directionin apico-coronal direction

3.3. The osseous crest lies in the coronal 1/3 of The osseous crest lies in the coronal 1/3 of the root to be extractedthe root to be extracted

4.4. Sufficient bone (4-6mm) beyond the apex for Sufficient bone (4-6mm) beyond the apex for primary stability of the implantprimary stability of the implant

ProblemsProblems

Prediction of bone level after healing is Prediction of bone level after healing is difficultdifficult

Fixture position may be compromisedFixture position may be compromised

Difficulty of complete flap closureDifficulty of complete flap closure