Extraction and Immediate Placement of Implant Sameer A. Mokeem King Saud University

Introduction The dental implants revolutionized the practice of dentistry and have become a successful, predictable treatment modality in partially and fully edentulous patients A healing period (6-12 months) after extraction was considered one of the most important factors for success of dental implants

Introduction Several studies clearly demonstrated the progressive alveolar bone atrophy occurring after loss of teeth in all directions The residual alveolar ridge might be inadequate to insert dental implants The insertion of dental implants into fresh extraction sites provided a realistic solution to overcome this problem

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

Introduction Immediate implant placement Delayed implant placement Staged implant placement

Definition Immediate implant placement occurs at the time of extraction Delayed implant placement is performed approximately 2 months post-extraction to allow soft tissue healing Staged implant placement allows for substantial bone healing within the extraction site that typically requires 4-6 months or longer

Success rate 90-95% Success rate 93.9% (Becker 1994)

Classification of Ridge Defects (Seiber 1989) Class I.Buccolingual loss of tissue with normal ridge height in an apicocoronal dimension Class II. Apicocronal loss of tissue with normal ridge width in buccolingual dimension Class III. Combination buccolingual and apicocoronal loss of tissue, resulting in loss of normal height and width.

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

Disadvantages Unfavorable implant angulation due to misalignment of the extracted tooth Failure to achieve the critical element of primary stability due to anatomical considerations Inability to perform primary closure

Indications Root fracture Crown fracture Endodontic failure Severe decay Unfavorable crown-root ratio

Contraindications Infected site (presence of purulent exudate) Insufficient depth for primary stability of the fixture Width of the extraction socket is less than 4-5 mm

Bone Implant Relationship Gelb (1993) –Class I:No wall defect –Class I:3 wall defects –Class III:Circumferential defects

Bone Implant Relationship Barzillay (1994) –Class I:Ideal bone –Class II:Space present at the coronal part –Class III:Space present at the lateral border

Bone Implant Relationship Salama and Salama (1993) –Class I:4 wall socket or 3 wall dehiscence type defect (5 mm vertically), adequate bone apically, adequate labial plate –Class II:Moderate defect (more 5mm) with gingival recession and moderate loss of labial plate

Bone Implant Relationship Salama and Salama (1993) –Class III:Vertical and bucco-lingual dimensions are inadequate, severe gingival recession, loss of labial plate

Bone Implant Relationship Meltzer (1995) –Class I:No wall defect, diameter of site is greater than that of fixture –Class II:Three wall intact, fourth wall has dehiscence or fenestration –Class III (1):Adequate ridge height but inadequate width –Class III (2):2 wall defect –Class IV:Inadequate vertical height

Ideal extracted sites are: 1.4 wall socket 2.3 wall dehiscence type defect (5 mm or less) in apico-coronal direction 3.The osseous crest lies in the coronal 1/3 of the root to be extracted 4.Sufficient bone (4-6mm) beyond the apex for primary stability of the implant

Problems Prediction of bone level after healing is difficult Fixture position may be compromised Difficulty of complete flap closure