outcomes of implant placement in post-extraction sockets

1. Dr Azade Cheraghzade
Dept. of prosthodontics, Dental School,
Shahid Beheshti University of Medical
Sciences

2.  INTRODUCTION
 STATEMENT OF PROBLEM
 PREOPERATIVE EVALUATION
 INTRAOPERATIVE EVALUATION
 POSTOPERATIVE EVALUATION
 SUMMARY
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4. 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.
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5. 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. Avinash S. Bidra. Evidence-Based Prosthodontics ;Fundamental Considerations, Limitations, and
Guidelines. Dental Clinics of North America 2014 ; Jan, 1-17.
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6. PATIENTS WANT TEETH
NOT
IMPLANTS!!
Carefully evaluate patient’s status
for
PREDICTABLE TREATMENT OUTCOMES
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7. November2014
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8. THE 3D DIAGNOSIS MODEL
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Ahmad I, Protocols for Predictable Esthetic Dental Restorations. 2nd
Edition, 2006, Blackwell

9. Medical
Periodontal
Oral Hygiene/Compliance
Occlusion
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Buser D, Belser C, ITI Treatment Guide. 2008, Vol 1

10. 1. PRE-OP EVALUATION
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12. ESTHETIC RISK ASSESSMENT
1) Patient’s expectations
2) Smoking
3) Lip height
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13.  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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o Visual inspection
o Trans gingival
probing
o Probe transparency
o Ultrasonic device
o CBCT imaging
Fu JH, Lee A, Influence of tissue biotype on implant esthetics. Int J Oral
Maxillofac Imp 20011;26:499-508

15. ESTHETIC RISK ASSESSMENT
1) Patient’s expectations
2) Smoking
3) Lip height
4) Gingival biotype
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16. 1. Guidelines for Immediate Implant Placement in Periodontally Compromised Patients, 2013
2. Crespi R, Cappare P, Gherlone E. Fresh-Socket Implants in Periapical Infected Sites in Humans.
J Periodontol ; 2010; 81(3): 378-383.
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20.  Bone quality and
quantity
 Socket Classification
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21. LEKHOLM & ZARB CLASSIFICATION (1985)
Lekholm & Zarb Classification (1985)
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22.  Bone quality and
quantity
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23. 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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24. November2014
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25. 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
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26. EXTRACTION DEFECT —
TYPE 1
Pristine, undamaged single-
rooted socket
Thick biotype
 systemically healthy
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Caplanis N, Lozarra JL, Kan JY. Extraction Defect: Assessment, Classification and
Management. International Journal of Clinical Implant Dentistry, 2009;1(1):1-11

27. EXTRACTION DEFECT —
TYPE 2
Any socket with up to mild
crestal bone loss or
 interproximal tissue loss of
2 mm
thin or thick biotype
 buccal plate thickness <1
mm, or any combination
systemically healthy
 1 socket wall is
compromised
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Caplanis N, Lozarra JL, Kan JY. Extraction Defect: Assessment, Classification and
Management. International Journal of Clinical Implant Dentistry, 2009;1(1):1-11

28. 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
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Caplanis N, Lozarra JL, Kan JY. Extraction Defect: Assessment, Classification and
Management. International Journal of Clinical Implant Dentistry, 2009;1(1):1-11

29. 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 healthy
Biotype either thick or
thin
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Caplanis N, Lozarra JL, Kan JY. Extraction Defect: Assessment, Classification and
Management. International Journal of Clinical Implant Dentistry, 2009;1(1):1-11

30. November2014
30Guidelines for immediate implant placement in periodontally compromised
patients; Dental Learning 2010; 4(6), 131-137

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32. Flap design
Ideal implant position
Adjunctive surgeries
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Bhat V, Bangawala MR, Immediate implant placement without flap
elevation - A Review. NUJHS; 2014;4(3): 131-137

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 Fradeani M, Esthetic rehabilitation in
fixed
prosthodontics. 2011

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37. Prevent bone resorption?
Effect on facial plate?
Effect on Dehiscence?
Antibiotics?
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Chen, Buser. Clinical and esthetic outcomes of implant placement in post-extraction soc

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Chen, Buser. Clinical and esthetic outcomes of implant placement in post-extraction soc
Chen, Buser. Esthetic outcomes of immediate implants in anterior maxilla, 2014

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40. Loading Protocols
Maintenance
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41. Immediate Early Conventional
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Touati B, Guez G. Immediate Implantation with provisionalization: From literature to
clinical implications; Pract Proced Aesthet Dent 2002; 14(9): 699-707

42. November2014
42Chen, Buser. Esthetic outcomes following immediate and early
implant placementin anterior maxilla,Int J Oral Maxillofac Imp 2014

43. 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
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44. 44

45. 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
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46. 2. 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
CONTRAINDICATIONS
RELATIVE
CONTRAINDICATIO
NS
Systematically
Healthy
Complicated systemic
diseases
Heavy smokers
Adequate soft tissue Maxillary sinus
involvement
Adequate hard tissue History of
bisphosphonates
Intact facial plate History of periodontal
disease
Thick tissue biotype Absence of intact labial
plate
Presence of active
infection
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48. Esthetic Risk
Factors
Low Medium High
Medical status
Healthy,
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 biotype
Low-
scalloped,
thick
Medium-
scalloped,
Medium-
thick
High-
scalloped,
thin
LOW
MEDIU
M
HIGH
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49. 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
defects
Bone anatomy of without bone Horizontal bone Vertical
MEDIU
M
HIGH
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51.  Proper diagnosis and implant position despite
challenges
 Need for further evidence
 The key to implant success is primary stability
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