Preservation of original architecture. 5 years follow up.
It is all about preserving whenever possible.
The benefits of immediate extraction and immediate implant placement as well as immediate loading is 3X IMMEDIATE.
These are the most important factors to succeed when performing this technique:
1-. Case selection:
- Attrition, high masseter. muscle activity, excessive tooth wear are all signs of muscular hyperactivity, a risk factor whenever thinking of immediately loading our implants. If needed it might require single unit loaded in addition to removal of all possible occlusal contacts and IPR on adjacent to avoid neighbouring teeth strong contact points.
- Smoking: The blood supply is limited in situations where smoking is present. The lack of vascularity will raise the chance of infection and early complications need to be assessed as soon as possible. When an implant is placed in this scenarios, please check the patient every 3 days to confirm integration and soft tissue maturation in absence of infection.
- Non plaque control: The bacterial proliferation is a common factor for soft tissue healing impairment and subsequent infection of deeper layers resulting on implant failure or localized infection that we will need to deal with in case of settlement. By monitoring your patient every 3 days post op you can control the plaque proliferation and act as soon as needed.
- Systemic factors associated with implant failure: High levels of cholesterol, Vit-D Deficiency, Diabetes, etc are some of the systemic factors that may address a failure in your implant cases so check the systemic status of the patient before deciding the prosthetic approach.
- The ridge anatomy must be favorable in terms of available bone and also appropriate density to achieve primary stability.
- The different implant designs allow the immediate implant placement not only to engage at the lingual or palatal bone but also the mesial & distal bone are even great areas that can be used to achieve primary stability as long as we keep the right prosthetic guide. You can check the Masterclass “Immediate implant placement and immediate loading on premolar site. A step by step procedure” and learn the technique to successfully treat this cases.
3-. Use of ISQ:
- To confirm the primary stability you can be assessed by the Implant Torque Value (ITV) and the Implant Stability Quotient (ISQ). Since they are two different values you can check the Masterclass “The rule o f 7 for no longer marginal bone loss” and find out why is this important when performing this technique.
4-. Soft Tissue presence:
- The presence of soft tissue at buccal and lingual sides will be mandatory especially in the aesthetic zone to provide the final crown with the appropriate size and correct implant 3D position.
5-. Quick osseointegrative surface:
- Different implant brands have different implant surfaces and the ones with quick osseointegrative surface feature are more predictable when performing this technique since reducing critical times will improve the final result, will make you more predictable, will encourage the hard and soft tissue maturation and will avoid complications derived from bacterial proliferation at early stages. So use implant brands that biologically are designed to reduce the time of osseointegration.