Since the 1960s, we have followed the guidelines established by Branemark. Today, scientific advances and patient demands have shortened the healing time. We have reduced it from 6 months to only 8 weeks. Loading is also initiated more quickly.
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Definition
Immediate implant placement involves placing an implant into the extraction socket during the same procedure.
Advantages
Lazzara introduced this technique in 1989. He demonstrated several advantages:
- Fewer surgical procedures.
- Preservation of bone and gums.
- Better osseointegration thanks to the natural healing of the socket.
- Fewer drilling steps, making implant placement easier.
- Better integration of the prosthesis in immediate esthetics.
- Positive psychological impact for the patient.
Key Points for Optimal Results
To achieve long-term stability, it is essential to keep the bone and gums stable around the implant.
Initially, bone resorption was a problem. Bone loss could reach up to 60% in 6 months. Today, we preserve the bone around the implant as much as possible.
- Check the vestibular bone table on the scan. If the bone is lost, plan for bone regeneration.
- Direct the implant toward the palatal or lingual side, as the vestibular wall is thinner.
- Place the implant subcrestally to limit resorption.
- The implant occupies less space than the socket. Choose a method to fill this gap.
Clinical Example
A 50-year-old woman consults to resume the root canal treatment of tooth 46. She continues to experience pain after her initial treatment. We propose extracting the tooth and placing an implant.
Two strategies are available:
- Extract the roots, wait 1 to 3 months for healing, then place the implant.
- Gently extract the tooth and immediately place the implant with an autogenous bone graft.
The second option has the advantage of involving only one procedure and limiting bone loss.
Surgical Procedure
- Administer anesthesia.
- Extract the remaining roots.
- Curette the socket.
- Retract the flap.
- Drill according to the standard protocol and position the implant as indicated by the scan.
- Place the implant on the septum and fill the socket with autogenous bone.
- Perform the suturing.
Patients desire rapid healing, less surgery, and less pain. We must achieve good results. Optimizing and stabilizing the bone around the implant is essential.
Immediate implant placement is a reliable and recognized method. Analyzing preoperative radiographs remains indispensable to properly prepare each case.
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