Immediate Implant Placement

Following Tooth Extraction:

A Case Series.
AJAYI YO,

IKEM OM,

ADEKUNLE AA
INTRODUCTION
The primary objective of implant therapy is aesthetic
replacement of missing teeth and long-lasting function of the
implant supported restoration.

The secondary objective is to provide treatment with the least

number of surgical interventions, low morbidity and short
healing period thus increasing the willingness of patients to
receive implant treatment.
Immediate implant placement, defined as the placement of
dental implant immediately into fresh extraction socket site
after tooth extraction, has been considered a predictable and
acceptable procedure.¹
2
Implant placement in post-extraction site could be done with 4
treatment options²;

1. Immediate implant placement (at the time of extraction);

2. Early implant placement following soft tissue healing (4 -8 weeks

post-extraction);

3. Early implant placement following partial bone healing (12 -16

weeks);

4. Late implant placement following complete bone healing

(>6months)
3
The advantages and disadvantages of immediate placement implants are highlighted below²

Advantages Disadvantages
 Risk of associated failures if the socket
 Cutback in number of surgical
becomes infected.
interventions
 Discrepancy between the implant
 Shorter treatment time,
surface and the socket wall, thus
 An ideal 3-dimensional implant creating gaps between bone and implant
positioning, thereby reducing the Bone Implant
Immediate
Implants Contact (BIC) and osseointegration may
 Preservation of alveolar bone at the
not take place if bone augmentation is
site of the tooth extraction and soft
not done.
tissue aesthetics
 Possibility of partial resorption or
 Excludes the need to raise a flap
missing bony socket wall either due to
thereby reducing tissue injury and
the disease processes or damaged as a
thus reduced healing time except with
result of traumatic extraction procedure.
guided bone regeneration.
4
To determine the success rate of implants
placed immediately into fresh extraction
sockets by clinical and radiographic
evaluation.

5
A total of 13 cylindrical implants over a period of 2years
(July 2016 – September 2018).
• 4 Sigma™ implants UK
• 9 Bicon™ implants Boston, US,
were placed at the Conservative Dentistry Clinic, Lagos
University Teaching Hospital (LUTH) immediately after
extraction in 11 subjects (6 males and 5 females)
between ages 21-70years.

6
• After informed consent and clinical photographs were taken,
extractions were carefully done to reduce trauma and alveolar
bone loss under Local Anaesthesia by an oral surgeon.

• A 2-staged surgical implant protocol was used. Implants were

placed at the 1st stage into the freshly extracted socket using
Sigma™ and Bicon™ kit and implants respectively. Primary
stability of implant at placement was ensured.
• For peri-implant defect greater than 2mm, a synthetic bone
graft (Syntho graft by Bicon™ USA) was used to fill the defect
to increase the Bone Implant Contact before suturing the
gingival margins to cover the implant. 7
None of the patients had active periodontitis prior to treatment.
POST SURGERY CARE:
• Medication: Cap Amoxicillin 500mg 8 hourly for 5 days
Tab Metronidazole 400mg 8 hourly for 5 days
Tab Ibuprofen 400mg 8 hourly for 5 days
Chlohexidene mouth rinse 12 hourly for 2 weeks.
• Post-Operative instructions were given.
• Post-Operative clinical photographs and radiographs were taken
• Patients were reviewed in a week and had sutures removed.

8
• The 2 nd stage surgery (3 months after implant placement) involved
exposure of cover screw under Local Anaesthesia, confirmation of
osseointegration, connection of abutment, impression making and
temporisation with a temporary crown.

• Clinical evaluation involved assessing dental implants for mobility,

pain, suppuration.

• Radiologic evaluation involved assessing for bone loss and peri

implant radiolucency with the use of periapical radiograph.
9
 Pie chart showing gender ratio

Mean age ± SD = 45.45 ±

12.79 Female
45% Male
55%

Success Rate = 92.3%

Male
Female

10
Implant Size of Age of sex Reason for extraction Outcome Bone
location implant patient augmentation
21 4x8 40 M Retained root Success No

11 4x8 60 M Failed PFM crown restoration due success No

to fracture of tooth
21 4x8 36 M Fractured non restorable root filled Success Yes
tooth
31 3x6 52 M Fractured, non restorable Success No

41 3x6 52 M Fracture, non restorable Success No

11 4x8 21 F Chronic periodontitis, necrosed and Success No

drifted buccally
35 4.5x6 60 M Failed non restorable crown Failed No
restoration 11
Implant Size of Age of Sex Reason for extraction Outcome Bone
location implant patient augmentation

36 5x6 60 M Failed non restorable crown Success No

restoration
11 4X8 49 M Failed post retained crown Success No

46 5x8 40 F Chronic pulpitis with grossly broken Success No

crown
14 4.2x8 41 F Retained root Success Yes
11 3.75x10 46 F Failed root canal treatment, fractured Success No
non restorable tooth
11 3.3x10 45 F Gingival recession and distolabially Success No
rotated lower incisor secondary to
Chronic periodontitis

12
• The success rate of immediately placed implants in this study
was 92.3%, which is comparable to the results from previous
studies.4,5 The criteria for success are no pain, no mobility, no
suppuration, no peri implant radiolucency, no marginal bone
loss greater than 1.5mm in the first year after implant
placement.
• 12 out of the 13 implants placed were restored with porcelain
fused to metal crown.
• Aesthetic evaluation of the soft tissue shows no gingival
recession or loss of papilla after one year of implant
placement.
13
• Implants placed into extraction socket usually exhibit a
discrepancy between the bony wall of the socket and the
implant known as the critical space or jumping distance.⁶ This
can be compensated for using wide diameter implants and
bone augmentation. However, when the critical space is less
than 2mm bone augmentation may not be required.⁷
• The use of short implants (6mm) for immediate placement in
fresh extraction socket will lead to a reduced Bone Implant
Contact (BIC) thereby affecting the survival of that implant.
This may be reason for the single implant (4.5 by 6mm) failure
in this study.
14
A B C

D E F
15
CASE 1

A. PROVISIONAL RESTORATION ON 21 B) FINAL RESTORATION PROCELAIN FUSED TO

METAL (PFM) CROWN ON 21

A B

16
CASE 1:

(A) Pre-op radiograph with (B) After implant placement (C) After insertion of PFM
fractured root filled tooth crown on abutment

A B C

17
CASE 2: (A) Baseline photograph showing gingival recession, fracture and
mesial drift of 41 & 31 in class 3 malocclusion (B)orthodontic correction of
malocclusion (C) Extraction and immediate Implants placement (D) Interrupted
sutures placed (E) Abutments placement at 2nd stage (F) Provisional restoration.
A B C

E F

D E
18
 CASE 2:

(A) Pre-op radiograph with

fractured, bone loss and drift of (B) After implants placement (C) After final restorations of
31 & 41 Of 31 & 41 PFM bridge replacing 31 &41

19
CASE 2: FINAL RESTORATION PFM CROWN ON 31 & 41

20
CASE 3: (A) Baseline photograph showing localized
periodontitis and distolabially rotated 41 (B) Post-extraction
(C) Implant placement (D) Provisional restoration on 41

A B

D
C

21
CASE 3:
(A) Pre-op radiograph showing (B) After implant placement (C) After insertion of PFM
bone loss and drifting teeth and provisional restoration crowns on abutment

A B C

22
CASE 3: FINAL RESTORATION OF 41
AND 41S

23
CASE 4: (A) Baseline photograph showing labially displaced discoloured 11 (B) placing
the implant (C) Implant placement (D) Interrupted sutures placed (E) Abutment
placement at 2nd stage (F) Provisional restoration on 11 &12.

A B C

D E F

24
CASE 4:

(A) Pre-op radiograph (B) After implant placement (C) After cementation of PFM
necrosed and displaced 2 unit cantilever bridge on
central incisor abutment
A B C

25
CASE 4: FINAL RESTORATION, 2 UNIT PFM CANTILEVER
BRIDGE

26
CASE 5: (A) RETAINED ROOT FRAGMENTS OF 14 POST EXTRACTION (B) SOCKET
AFTER EXTRACTION (C) PARALLELING PIN PLACEMENT (D) IMPLANT INSITU (E)
SIMPLE INTERRUPTED SUTURES TO COVER EXTRACTION SOCKET (F) ABUTMENT
PLACED AFTER 3MONTHS

A B C

D E F

27
CASE 5: (A) PROVISIONAL RESTORATION ON 14 (B) FINAL RESTORATION
PFM ON ABUTMENT REPLACING 14

A B

28
PERIAPICAL RADIOGRAPHS OF CASE 4 SHOWING (A) PRE-TREATMENT WITH
REATINED ROOTS OF ROOT TREATED 14 (B) AFTER IMPLANT PLACEMENT (C)
FINAL RESTORATION WITH PFM CROWN

A B C

29
• The 92.3% success rate in this study shows that
immediate dental implant placement is a viable
placement protocol.
• However, case selection, proper diagnosis,
treatment planning and primary initial stability
are very important factors for the success of an
immediate implant.

30
1. Ebenezer VK, Balakrishnan R, Vigil DA, Sragunar B. Immediate placement of
endosseous implants into the extraction sockets. J Pharm Bioallied Sci. 2015 Apr;
7(Suppl 1): S234–S237.
2. Chen ST Buser D. Clinical and Esthetic Outcomes of Implants Placed in Postextraction
Sites. Int J Oral Maxillofac Implants 2009;24(Suppl): 186-217.
3. Chen S, Wilson Jr TG, Hämmerle CH. Immediate or early placement of implants
following tooth extraction: review of biologic basis, clinical procedures, and
outcomes. Int J Oral Maxillofac Implants, 2004; 19(Suppl):12-25.
4. Shwartz-Arad D, Grossman Y, Chaushu G. The clinical effectiveness of implants placed
immediately into fresh extraction sites of molar teeth. J Periodontol.2000; 71:839-844
5. Chrcanovic BR, Martins MD Wennerberg A. immediate placement of implant into
infected sites. A systematic review. Clinical implant dentistry and related
research.2015 Jan:17 Suppl 1:e1-e16
6. Botticelli D, Bergiundh T, Buser D, Lindhe J. The jumping distance revisited: An
experimental study in the dog. Clin Oral Imp Res 2003; 141: 35-42
7. Schropp L, Kostopoulos L, Wenzel A. Bone healing following immediate versus deyed
placement of titanium implants into extrcation sockets. A prospective clinicals study. 31
Int J Oral Maxillofac Imp 2003; 182: 189-199