Reports on the ADI Team Congress 2011
Thursday 14 - Friday 15 April
Manchester Central Convention Complex
Petersfield, Manchester M2 3GX
Immediate implant placement: is it safe and predictable?
Speaker: Dr Stephen L Wheeler DDS – USA
Reported by Philip Friel
Whilst the appeal of immediate implant placement may be great in terms of decreased surgical requirement, total procedure time and time in temporaries, it is essential to ensure that any such procedure can be termed safe and predictable in terms of implant survival and aesthetic success.
Bone and soft tissue maintenance and stability represent the long-term requirement of immediate implant placement in the aesthetic zone. However, it is known that bone will be lost in all dimensions after extraction, so how can we safely and predictably maintain it?
It was previously proposed that obliterating an extraction socket with an immediately placed implant would support the buccal bone over time, however, such techniques in time showed poor aesthetic success. From there, immediate placement of implants aimed to preserve buccal bone plate and the blood supply to it by placing immediate implants in a more palatal position, filling the resulting void between implant and buccal plate. There remains debate with regards to the optimum width of this void and indeed what it should be filled with. Buccal plate preservation at extraction in immediate implant placement is now a generally accepted prerequisite for success.
The proposed site in potential immediate load cases must be extensively and comprehensively assessed for success and in addition the skill and experience of the operator plays an important part. Whilst technological advances in both implants and planning may make immediate placement planning more accurate, the learning curve with immediate implant placement can be steep and costly, particularly in the aesthetic zone. If all requirements for successful immediate implant placement are not present, then a staged approach should be followed - in the words of Dennis Tarnow, “lets only attempt to accomplish one miracle at a time.”
Is immediate placement safe? Yes it is. Is it predictable? It can be, so long as stringent planning and very strict guidelines are followed with regards to case assessment.