There are many advantages to immediate implant placement when delivering treatment for edentulous patients. Studies have shown that with the right clinical approach, there is no significant difference in survival rates between implants placed with immediate or delayed protocols.
Immediate implants may prevent disuse atrophy, and crestal bone loss may be less significant. The decreased surgical trauma of immediate placement not only benefits the patient in terms of reduced chair time, but may also create more favourable conditions for woven bone to be transformed into lamellar bone.
However, careful patient selection is paramount. Maintaining ongoing evidence-based knowledge and understanding about the indications, contraindications and other considerations concerning immediate versus delayed placement protocols is essential when developing advanced practice.
Indications
In general, patients who have experienced minimally traumatic tooth loss or extraction, without purulent exudates or cellulitis, who have adequate soft tissue and sufficient apical and palatal bone volume can be considered for immediate implant treatment.
Periodontally healthy patients, with a thick gingival biotype, intact buccal bone wall, with both neighbouring teeth may additionally benefit from a low risk of aesthetic complications when treating tooth loss with immediate implants in the anterior regions.
Contraindications
Taking a detailed patient history is an important precursor for any treatment. For example, if a patient’s healing capacity is compromised by health conditions like diabetes, medications such as bisphosphonates and derivatives, or if the patient is a smoker, a heavy drinker, or if they have poor oral hygiene, immediate implant treatment would not be recommended.
The presence of any active infection is generally a cause for concern, although some evidence has shown positive outcomes for immediate implants with the use of plasma rich in growth factors (PRGFs) during placement. The presence of purulent exudates at the time of extraction indicates the presence of an infection that should often be treated before proceeding with implant treatment. Likewise if there is any evidence of adjacent soft tissue cellulitis, treatment should be delayed.
Immediate implant placement is also not indicated in the presence of granulation tissue. An important component in the wound healing process, the granulation tissue matrix fills wounds where edges do not approximate. When granulation is present, most studies recommend debridement of the implant site before placement, or antibiotics to support the healing process before proceeding with implant treatment.
Achieving optimal results
Ultimately, the main factor determining the success of immediate placement is primary stability. As well as the design of the implant itself, the quality of bone in the edentulous area is a key concern. For example, there is a higher association of implant failures in type C dental sockets, which are defined as having little or no bone on the septal wall, requiring the implant to engage in the edge of the socket. Immediate placement would not normally be indicated in such cases.
A buccal wall thickness of at least 2mm is recommended to achieve optimal results when immediately placing implants. Augmentation procedures are required below this threshold, involving the use of graft materials to fill the buccal gap during placement. In addition to this, consideration should be given to other influencing factors, such as the flap versus flapless approach, socket anatomy, remaining buccal bone thickness, gingival phenotype, gap size, and implant material.
Recently studies and analyses on the efficacy of bone and soft tissue grafting techniques have shown that they can enhance immediate implant treatment. Though not always essential, are a valuable resource to prevent significant tissue reduction, reaching positive bone stability and favourable pink aesthetic and visual analogue score levels.
Specialist oral surgeon Professor Cemal Ucer presents an opportunity to learn more through the Advanced Certificate in Management of Tooth Loss: Immediate Implants vs. Socket Preservation. This two-part course at ICE Postgraduate Dental Institute and Hospital features evidence-based workshops and lectures covering minimally traumatic extraction techniques, socket preservation, both analogue and digital workflows, socket augmentation, and alveolar ridge preservation.
With the right patient selection strategy and the right knowledge and skills, immediate implants can be a highly effective and predictable treatment option for edentulism. Employing this approach to implant treatment can significantly reduce the duration of treatment, giving patients the aesthetics and function they need in less time.
References available on request.
For more information visit https://ucer.education