Download - Fresh socket implant placement
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Dr Azade CheraghzadeDept. of prosthodontics, Dental School, Shahid Beheshti University of Medical
Sciences
OUTCOMES OF IMPLANT PLACEMENT
IN POST-EXTRACTION SOCKETS
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OUTLINE INTRODUCTION STATEMENT OF PROBLEM PREOPERATIVE EVALUATION INTRAOPERATIVE
EVALUATION POSTOPERATIVE
EVALUATION SUMMARY
November 2014
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November 2014
INTRODUCTION
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1. Wagenberg BD, Ginsburg TR. Immediate implant placement on removal of the natural tooth: retrospective analysis of 1,081 implants. Compendium of Continuing Educ Dent 2001;22:399-404.
2. Cooper LF, Rahman A, Moriarty J, et al. Immediate mandibular rehabilitation with endosseous implants: simultaneous extraction, implant placement, and loading. Int J Oral Maxillofac Implants 2002;17:517-25.
History
Schuelte (1976)
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51. Wagenberg BD, Ginsburg TR. Immediate implant placement on removal of the natural tooth: retrospective analysis of 1,081 implants. Compendium of Continuing Educ Dent 2001;22:399-404.
2. Avinash S. Bidra. Evidence-Based Prosthodontics ;Fundamental Considerations, Limitations, and Guidelines. Dental Clinics of North America 2014 ; Jan, 1-17.
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PATIENTS WANT TEETH
NOT IMPLANTS!!
Carefully evaluate patient’s status for
PREDICTABLE TREATMENT OUTCOMES
November 2014
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PATIENT IDENTIFICATION November 2014
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THE 3D DIAGNOSIS MODEL
Clinical exam. Radiographic exam.
Risk prediction
3D
Diagnosis
November 2014
Ahmad I, Protocols for Predictable Esthetic Dental Restorations. 2nd Edition, 2006, Blackwell
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GENERAL RISK FACTORSMedical
Periodontal
Oral Hygiene/Compliance
Occlusion
November 2014
Buser D, Belser C, ITI Treatment Guide. 2008, Vol 1
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1. PRE-OP EVALUATION
Pre-Op Evaluation
November 2014
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November 2014
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ESTHETIC RISK ASSESSMENT1) Patient’s expectations
2) Smoking
3) Lip height
4) Gingival biotype
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4) GINGIVAL BIOTYPE
Thick Vs. Thin
Thick Vs. Medium Vs. Thin
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Fu JH, Lee A, Influence of tissue biotype on implant esthetics. Int J Oral Maxillofac Imp 2011;26:499-508
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MEASUREMENT TECHNIQUES
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o Visual inspectiono Trans gingival
probingo Probe
transparencyo Ultrasonic deviceo CBCT imaging
Fu JH, Lee A, Influence of tissue biotype on implant esthetics. Int J Oral Maxillofac Imp 20011;26:499-508
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ESTHETIC RISK ASSESSMENT1) Patient’s expectations
2) Smoking
3) Lip height
4) Gingival biotype
5) Infection at the
implant site
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5) INFECTION
1. Guidelines for Immediate Implant Placement in Periodontally Compromised Patients, 20132. Crespi R, Cappare P, Gherlone E. Fresh-Socket Implants in Periapical Infected Sites in Humans. J Periodontol ; 2010; 81(3): 378-383.
o Acute Vs. Chronic
o Long term tissue stability
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17ESTHETIC RISK ASSESSMENT
6) SHAPE of the missing and adjacent teeth
7) BONE LEVEL at adjacent teeth
8) RESTORATIVE STATUS of the adjacent
teeth
9) Characteristics of the edentulous space
10)Width of hard and soft tissue
11)Height of hard and soft tissue
November 2014
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2. Intra-Op Evaluation November 2014
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2. INTRA-OP
EVALUATION
SITE ASSESSMENT (Where?)
TIMING OF IMPLANT
PLACEMENT (When?)
TECHNICAL CONSIDERATIONS
(How?)
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SITE ASSESSMENT
Bone quality and
quantity
Socket Classification
November 2014
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LEKHOLM & ZARB CLASSIFICATION (1985)
Lekholm & Zarb Classification (1985) November 2014
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SITE ASSESSMENT
Bone quality and
quantity
Socket
Classification
November 2014
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1) Closed - contained - Extraction socket
2) One Wall - Dehiscence, Fenestration
3) Multiple Wall Defects - Horizontal Defect
4) Vertical Defect
BONE DEFECTS
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November 2014
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EXTRACTION DEFECT SOUNDING,
CLASSIFICATION
Caplanis N, Lozarra JL, Kan JY. Extraction Defect: Assessment, Classification and Management. International Journal of Clinical Implant Dentistry, 2009;1(1):1-11
EDS, Classification
November 2014
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EXTRACTION DEFECT — TYPE 1
Pristine, undamaged single-rooted socket
Thick biotype systemically healthy
November 2014
Caplanis N, Lozarra JL, Kan JY. Extraction Defect: Assessment, Classification and Management. International Journal of Clinical Implant Dentistry, 2009;1(1):1-11
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EXTRACTION DEFECT — TYPE 2Any socket with up to
mild crestal bone loss or interproximal tissue loss
of 2 mmthin or thick biotype buccal plate thickness
<1 mm, or any combination
systemically healthy 1 socket wall is
compromised
November 2014
Caplanis N, Lozarra JL, Kan JY. Extraction Defect: Assessment, Classification and Management. International Journal of Clinical Implant Dentistry, 2009;1(1):1-11
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EXTRACTION DEFECT — TYPE 3
Moderate compromise of the local tissues
Systemically healthy Vertical or transverse
hard- and/or soft tissue loss of 3 to 5 mm
1 or 2 compromised socket walls
Thick or thin biotype
November 2014
Caplanis N, Lozarra JL, Kan JY. Extraction Defect: Assessment, Classification and Management. International Journal of Clinical Implant Dentistry, 2009;1(1):1-11
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EXTRACTION DEFECT — TYPE 4
Severely compromised socket
Greater than 5 mm vertical or transverse loss of hard and/or soft tissue
2 or more reduced socket walls
Systemically healthyBiotype either thick or
thin
November 2014
Caplanis N, Lozarra JL, Kan JY. Extraction Defect: Assessment, Classification and Management. International Journal of Clinical Implant Dentistry, 2009;1(1):1-11
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POSTERIOR AREASComplications
Anatomic structures
Bone DensityAccessSoft tissue
Contraindications
November 2014
Guidelines for immediate implant placement in periodontally compromised patients; Dental Learning 2010; 4(6), 131-137
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November 2014
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SURGICAL CONSIDERATIONS
Flap design
Ideal implant position
Adjunctive surgeries
November 2014
Bhat V, Bangawala MR, Immediate implant placement without flap elevation - A Review. NUJHS; 2014;4(3): 131-137
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IDEAL IMPLANT POSITION
November 2014
Fradeani M, Esthetic rehabilitation in fixed
prosthodontics. 2011
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November 2014THE BONY GAP?!
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November 2014
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November 2014
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Regenerative outcomes (Effectiveness)
Prevent bone resorption?
Effect on facial plate?
Effect on Dehiscence?
Antibiotics?
November 2014
Chen, Buser. Clinical and esthetic outcomes of implant placement in post-extraction sockets, 2009
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Esthetic Outcomes
Soft tissue Alterations?
Risk indicators?
November 2014
Chen, Buser. Clinical and esthetic outcomes of implant placement in post-extraction sockets, 2009Chen, Buser. Esthetic outcomes of immediate implants in anterior maxilla, 2014
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39 3. POST-OP EVALUATION
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3. POST-OP EVALUATION Loading
Protocols
Maintenance
November 2014
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LOADING PROTOCOLS
Immediate Early Conventional
November 2014
Touati B, Guez G. Immediate Implantation with provisionalization: From literature to clinical implications; Pract Proced Aesthet Dent 2002; 14(9): 699-707
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November 2014
Chen, Buser. Esthetic outcomes following immediate and early implant placementin anterior maxilla,Int J Oral Maxillofac Imp 2014
Immediate Loading
Prosthetic Requirements
Immediate Vs. Conventional Loading?
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SURVIVAL RATE? > 95%
1. Martínez JP , Pascual TP, Bueno SM, Immediate implants following tooth extraction: A systematic review. Med Oral Patol Oral Cir Bucal. 2012;17 (2): 251-61. Chen, Buser. Esthetic outcomes of immediate implants in anterior
maxilla, 2014
MAINTENANCE November 2014
Patient Satisfaction?
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SUMMARY
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1. Prasad DK, Mehra D, Prasad DA, Recent advances, current concepts and future trends in oral implantology: Indian Journal of Oral Sciences, 2014; 5(2): 55-62
2. Misch CE, Dental implant prosthetics 2015
Advantages
Disadvantages
November 2014
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462. Immediate Implant Placement: Clinical Decisions, Advantages, and Disadvantages. Monish Bhola, Anthony L. Neely, Journal of Prosthodontics17(2010) 576–581 .
1. Immediate Implant Placement: Positive and Negatives. Richard U. Koh, Ivan Rudek, Hom-Lay Wang, IMPLANT DENTISTRY /VOLUME19, NUMBER2 2010 : 98-105
INDICATIONS ABSOLUTE CONTRAINDICATIO
NS
RELATIVE CONTRAINDIC
ATIONSSystematically
HealthyComplicated
systemic diseasesHeavy
smokersAdequate soft
tissueMaxillary sinus
involvementAdequate hard
tissueHistory of
bisphosphonatesIntact facial
plateHistory of
periodontal disease
Thick tissue biotype
Absence of intact labial plate
Presence of active infection
November 2014
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Criteria for
Case Selection
November 2014
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Esthetic Risk Factors
Low Medium High
Medical statusHealthy,Intact
Immune System
-
Compromised Immune System
Smoking Non-smoker
Light smoker(<10 cig/d)
Heavy smoker (>10 cig/d)
Esthetic expectations
Low Medium High
Lip line Low Medium High
Gingival biotypeLow-
scalloped, thick
Medium-scalloped,Medium-thick
High-scalloped,thin
Shape of tooth crowns
Rectangular
- Triangular
LOW MEDIUM HIGH Novem
ber 2014
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Infection at implant site None Chronic Acute
Adjacent teeth bone
level
≤5 mm to contact point
5.5-6.5 mm to contact point
≥7 mm to contact point
Adjacent teeth
restorative status
Virgin - Restored
Width of edentulous
span
1 tooth (≥7 mm)
1 tooth (≥5.5 mm)
1 tooth (<7 mm)
1 tooth (<5.5 mm)
2 teeth or more
Soft tissue anatomy
Intact soft tissue
- Soft-tissue
defectsBone
anatomy of alveolar crest
without bone deficiency
Horizontal bone
deficiency
Vertical bone
deficiency
MEDIUM HIGH
November 2014
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FACTORS INFLUENCING DECISION-MAKING Scientific
documentationBenefit for the patient
Risk for complications
Difficulty of treatment
(SAC Classification) Cost-effectiveness
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CONCLUSION
Proper diagnosis and implant position despite
challenges Need for further evidence The key to implant success is primary
stability
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Thank you
November 2014