When a tooth is extracted, it leaves behind an empty socket in the jawbone. This leads many patients to wonder if a dental implant can be immediately placed into this extraction socket to replace the missing tooth. Immediate implant placement has become an increasingly popular option, but it’s not suitable for every patient and case. There are several factors the dentist must consider when determining if placing an implant immediately after extraction is appropriate.
What is immediate implant placement?
Immediate implant placement, also known as immediate loading or immediate restoration, is a procedure in which a dental implant is placed into a newly extracted tooth socket right away during the same surgery. A temporary crown or denture may be attached to the implant to provide the patient with a prosthetic tooth while the implant integrates with the bone, which can take 3-6 months. Once integrated, the temporary crown is removed and a permanent crown attached to the implant.
The key benefit of immediate implant placement is that it allows tooth replacement to begin immediately after extraction without having to wait months for the bone and soft tissue to heal before implants can be placed. This prevents bone loss that normally occurs after extractions and eliminates the need for additional surgical procedures later on to place the implant.
When is immediate implant placement appropriate?
While appealing for reducing treatment time and surgical procedures, immediate implant placement is not appropriate for every case. The dentist must carefully evaluate several factors to determine if it can be done or if a conventional approach with a healing period is better for the patient’s unique situation.
Some factors that help determine candidacy include:
Condition of the extraction socket:
Ideally, there should be intact bone walls around the socket with adequate bone volume and density to stabilize the implant. Severely damaged sockets may not offer enough bone support.
Health of the surrounding hard and soft tissues:
There should be healthy gum tissues free of active infections or diseases like advanced periodontitis which could compromise implant integration and success.
Reason for tooth extraction:
Immediate implant placement is not recommended if extractions are due to advanced gum disease, tooth fractures, cysts, or tumors since this could increase implant failure risks. More time may be needed to resolve these issues before placement.
Occlusion and space for restorative needs:
The bite alignment and space available must be evaluated to ensure proper position and angulation of the implant for ideal aesthetic and functional prosthetic restoration.
General health conditions:
Factors like uncontrolled diabetes or osteoporosis may interfere with healing after immediate placement. The dentist must assess overall health risks.
Patient compliance:
The patient must be willing and able to follow post-op care instructions like avoiding chewing on the implant site during the initial healing phase.
Advantages of immediate implant placement
When deemed appropriate based on the patient’s case, there are significant advantages to immediate implant placement after extraction:
- Reduces overall treatment time – Avoid months of waiting for healing between extraction and implantation.
- Preserves bone at the extraction site – Implant placement right after extraction helps maintain bone volume which deteriorates quickly once a tooth is missing.
- Improves aesthetic outcomes – Immediate implantation allows optimal implant positioning for the most natural tooth replacement and smile aesthetics.
- Eliminates need for temporary prosthesis – The implant acts as the temporary prosthetic during the osseointegration phase, eliminating the need to use removable dentures.
- Reduces costs – Eliminates additional surgery later for implantation, reducing overall expenses.
- Improves patient comfort – Patients enjoy a shorter overall treatment time and are able to have a restoration placed immediately.
These benefits make immediate implantation an attractive option for the right candidates.
Risks and complications
While offering advantages, immediate implant placement also comes with risks and possible complications that must be considered:
- Higher failure rates – Some studies show slightly higher failure rates for immediately placed implants vs. delayed placement due to disturbances in the healing socket.
- Infection – Bacterial contamination in the extraction socket can lead to infection and implant failure.
- Malpositioning – Difficulties seeing bone anatomy in the fresh socket can result in improper implant angulation.
- Bone graft needs – Bone grafts may still be required to rebuild damaged sockets prior to implantation.
- Aesthetic problems – Recreating natural looking tooth contours and tissue profiles can be challenging with immediate placement.
- Wound dehiscence – The wound over the implant may open up and expose the site to infection.
- Increased bone loss – Is primarily an issue if the implant develops an infection.
Proper case selection, surgical techniques, and patient compliance help reduce risks for successful outcomes.
The immediate implant placement procedure
If selected as an appropriate candidate, here is a general overview of what a patient can expect during immediate implant placement after a tooth extraction:
Administration of anesthesia
The surgery is performed under adequate local anesthesia to keep the patient comfortable. Sedation may also be provided.
Tooth extraction
The tooth is carefully extracted trying to preserve the walls of the socket which will house the implant.
Socket evaluation and debridement
The dentist will then evaluate the extraction socket, looking for any defects needing bone grafts and thoroughly cleans out debris.
Implant insertion
Using precision guides, the implant is inserted into the fresh socket in the ideal position and depth. Stability is checked.
Placement of temporary abutment and crown
A temporary abutment is placed on the implant to act as the new tooth root. A temporary crown is secured on top to complete the restoration.
Suturing
The gingival tissues around the implant are sutured closed to allow for undisturbed healing.
Post-op care
Antibiotics, pain medication, and chlorhexidine oral rinse may be prescribed. The patient is given detailed post-op care instructions to follow.
Healing, osseointegration, and final restoration
Once the implant is placed, healing and osseointegration with the jawbone will take about 3-6 months. During this period, the implant and surrounding bone and soft tissues regenerate and integrate together to form a strong foundation for the final tooth replacement.
The patient is typically seen for follow-up checks during this period to monitor their progress. Once healed, the temporary crown is removed, and a custom-made permanent crown is attached to the implant via the abutment. With proper hygiene and care, the implant can then functionally last many years.
Frequently asked questions
How long does immediate implant placement surgery take?
The procedure is often completed within 1-2 hours, including the extraction, implantation, and placement of a temporary prosthesis. Total time depends on the specifics of each case.
What type of implants are used?
Most commonly, endosteal screw-like implants made from titanium are used for immediate placement. They integrate best with the jawbone. Zirconia implants may also be an option.
Will I need bone grafting?
It depends on the quality of the socket. Grafts may be placed around the implant to augment bone volume if defects are detected. Membranes may also aid bone regeneration.
How much does it cost compared to conventional implantation?
There is usually little to no additional cost for immediate implant placement since it eliminates the need for grafting procedures later on before conventional implantation.
What care is required after the surgery?
Patients must follow post-op instructions like using ice packs, eating soft foods, avoiding certain activities, and taking any prescribed medication to allow proper healing without complications.
When can the temporary crown be replaced with a permanent one?
Typically after 3-6 months. The dentist will evaluate the implant integration first before taking this next step.
Is immediate implant placement painful?
There may be some mild postoperative discomfort which is managed with pain medication. There is usually less pain compared to waiting for delayed placement later since that requires creating a second surgical site.
Conclusion
Immediate implant placement into fresh extraction sockets offers many benefits for the right candidates, including shorter treatment time, bone preservation, cost savings, and improved aesthetics. Patients must be carefully evaluated for this procedure, and dentists highly skilled in implant techniques are needed for optimal results. While some risks such as infections and malpositioning exist, they can be well managed. Following post-op protocols speeds healing and integration. With meticulous case selection and execution, immediate implant placement can be an excellent option for many patients wanting to immediately replace a lost tooth with a stable and functional dental implant.
