PERIO

2. German group under the leadership of
Professor WILLY SCHULTE, 1978 who
recommended the so called “
TUBINGER SOFORT IMPLANTANT .
He proposed the concept of IIP using
aluminum Oxide implants
This attempts was unsuccessful not
because of the t/t approach but Rather
the failure of biomaterial itself.
Aluminum Oxide Implants Showed High Rate Of Complications
& Failures Due To Implant Fractures
Professor WILLY SCHULTE

4. •‘Drilling Feeling’ Trisi et al,COIR,1999
Good to distinguish between D-1 & D-4 Bone
But not between D-2 & D-3
•Insertion Torque Mechanism Friberg et al,COIR,1995
Limited only to Self-Tapping Implants,
A value of 45 Ncm has been advocated
•Radiographic
CT Scan, Simplant 400-450 Hensefield Units
Sundan et al., COIR,1995:6;220-226
Reproducibility Standardisation Radiation,Time needed
Cochran,1998

5. Factors for Early Loading of Immediate Implants
Kotsuyama,et al.Quintessence Dental Implantology,7(3)
357-367:2000
•Sufficient Primary Stability
•Soft Tissue Healing(2-3) weeks
•Healthy Bone Quality(Density) - 400-450 HU(Cochran)

6. Placement of Immediate Implant in Infected Sites
Nir-hader, Orly et al.
COIR,1998
Delayed Immediate Implant
better option in Infected sites
Ivorio,Giovanni,
Costigliola,G et al.
COIR,12(4),2001
Clinical,Prospective,n=130
N=36(Infected sites),
3-5 year survival rate
Overall Survival-97%
Failure- 6 Implants(PA PD’itis)
Survival rate-87%(In infected sites)

7. Immediate Loading of Immediate Implants
Ormiener et al COIR 2001,August
Multicenter, Clinical ,Prospective,Randomized, N=546
“Immediate Loading / Immediate Implants is a predictable procedure”
10 implants failed out of 546
Lorenzi,M et al,2002
Clinical, N=9 pat,Ant. Maxilla 50%-II,50%-Del.I
Periotest,Radiographs
Out of centric contact, Occlusal Splint-8 weeks
Success Rate- 96%

8. Placement of Immediate Implant in Infected Sites
Novaes & Novaes
IJOMI,1995
1st Report
Chronic Peri-apical Infected sites
Novaes et al ,
IJOMI,1998
Experimental,Canine,Histological
BIC is Higher in Non-Infected sites than in
Infected sites
Grunder et al ,
IJOMI,1999,
14:210-216
Clinical, Prospective,3 year Study
Increased Implant Failure,if the tooth
replaced was lost for Periodontal Infection

9. • Dahlin-JOMI,89
•Lazzara-IJPRD,89
•Becker-JP,90
•Nyman-JOMI,90
•Schwartz-JOP,97
•Gilb-JOMI,93
•Wilson-JOMI,98
•Paolantonio-JP,01
•Cornelini-JOMI,00
•Becker-Perio-2000

10. 6-12 months healing is recommended following
tooth extractions prior to dental implant
placement
Adell et al ,1981

11. Over the past 16 years numerous studies have confirmed the
reliability of implants placed in the post extraction sockets.
In 1989, Lazzara evaluated the Surgical and Restorative advantages of
implants placed in post extraction sockets.
Hammerle el al 2004 – in the consenses report made immediate Implant
placement on the same procedure along with tooth extraction he stated
Immediate Implant placement has optional availability of existing bone for
implant placement & reduced overall treatment time.
Several prospective studies (Yokuna 1991, Becket et al 1998, 1999,
Polizzi, al 2000, Retrospective studies (Held 1993, Gold stein et al 2002
Watzek et al 1995) reported high Success Rates of implants.

12. Lindquist el all 1998, Von Wowern el al 1990, Dennisen et all 1993, Werbitt
& Goldberg 1992), that Immediate implant placement in fresh extraction
sockets may counteract the Alveolar bone Resorption that resultsing
reduction of Ridge dimentions
The overall procedure has proven to have a positive psychological impact
on the patient (Gelb 1993, Cornelini et al. 2000, Kan and Runsaeng 2000).

13. (Araujo et al, 2005, 2006) (Botticelli et al 2006) studies in human (covani et al
2003, 2004) (Botticelli et al 2004) and (Araujo et al 2005) studies In animals
showed IIP failed to prevent the resorption of buccal bone
MARIANO SANZ et al 2009, that the thickness of the buccal bone wall as well
as the dimension of the horizantal gap influenced the hard tissue alterations that
occur following IIP into extraction sockets.
DOTT .DANIELE BOTTICELLI et al 2010 did an analysis on hard tissue formation
adjacent to implants of various size and configuration immediately placed into
extraction sockets and claimed that the installment of root formed wide
implants immediately into extraction sockets will not prevent the resorption of
the alveolar crest

14. Anatomic Configurations after tooth Extraction
CLASSIFICATION OF IMPLANT PLACEMENT
1. Immediate - Same day as extraction
2. Recent - 30-60 days after extraction
(Soft tissue healing )
3. Delayed - Following hard tissue maturation
4. Mature - 6 months to years after extraction
Wilson & Weber - (1998) – Implant placement
Immediate - Same day as extraction
Delayed - 42 – 70 days after extraction
Late - 6 months after extraction
Mayfield et al - (1999)

15. Type I - Fresh extraction sockets as a part of the same surgical
procedure
Type II - After complete soft tissue coverage of the socket (4-8
weeks )
Type III- After substantial clinical and Radiographic bone fill of
the socket (12 – 16 weeks )
Type IV- In a healed socket (More than 16 weeks)
Hammerie et at (2004)
Immediate - In fresh extraction socket
Immediate delayed - Within 8 weeks after extraction
Delayed - After 8 weeks
Esposito et al (2006)

16. Classification of Immediate Implant Placement Sites
(Int J Periodontics and Restorative dent : 2007:27: 313-323) -
Akiyoshi Funato et al Classification is based on Osseous & Soft tissue levels of
site of extraction.
Class I - Buccal bone Intact
Thick gingival biotype
Flapless Implant placement
Class II - Buccal bone Intact
Thin, scalloped gingival biotype
Immediate implant placement +
connective tissue graft or staged CTG .

17. Class III - Buccal bone is Lost and IIP+ GBR+
bone grafts + CTG.
- Depending on degree compromises
of buccal plate , Case alternatively
handled with staged approach.
- Indication for IIP is limited.
Class IV -Buccal bone is Severely compromised
- IIP remaining palatal bone.
- Results in significantly off Axial
Implant placement .
-So implant should be delayed (Type IV)
If implant is placed Immediately Implant inclines
towards buccal & will result in Significant
esthetic compromise.
Int J Periodontics RestorativeDent 2007;27:313–323.)

18. Some authors (Schwartz-Arad and Chaushu 1997) used autogenous
bone chips without using barrier membranes to fill the osseous
defect with a high survival rate.
The use of grafting material to fill the peri-implant space within the
socket has also been extensively studied
autogenous bone chips and block garafts were predominantly used
(Buser and coworkers 1998)
Stephen et al 2009, used implant bone rings , one stage 3-d bone
transplant technique . bone rings were outlined in the symphysis
area using trephine burs

19. Platelet Rich Plasma
Platelet rich plasma (PRP) – results from the sequestration and concentration
of platelets and therefore many growth factors.
The strategy behind the use of PRP is to amplify and accelerate the effects of
growth factors present in platelets. PRP can be prepared in office by
centrifuging small volume of autologous blood.
Stephen et al 2009, used implant bone rings , one stage 3-d bone transplant
technique . bone rings were outlined in the symphysis area using trephine burs
JOURNAL OF ORAL IMPLANTOLOGY2009

20. The use of the demineralized, freeze-dried bone allografts
(DFDBA) hasbeen extensively investigated as well (Block and Kent
1991
Allografts are available in powder or putty – like forms.these materials
may induce healing through osteoconduction , osteoinduction or a
combination of both processes
DFDBA may regenerate bone by osteoinduction, by its effect on the
host’s undifferentiated mesenchymal cells while blood vessels
penetrate the graft.
Allografts
Allografts , such as demineralised or mineralized freeze –dried bone
(DFDBA and FDBA) are often used in place of autograft

21. The utilization of barrier membranes started in late 1988 to
regenerate peri-implant defects using e-PTFE membranes (Lazzara,
1989; Nyman and coworkers, 1990; Buser and coworkers, 1990).
In the mid-1990s, resorbable barrier membranes became more
commonplace (Hurzeler and Strub, 1995; Hutmacher and coworkers,
1996).
Today, bioresorbable barrier membranes dominate in implant
dentistry, since they are relatively easy to apply during surgery, have a
low risk of complications in case of soft-tissue dehiscences, and do not
require a second surgical procedure for membrane removal.
GBR membranes are used to separate
• tissue during healing,
• retard apical migration of epithelium to the site,
• maintain the necessary space for bone in-growth (tenting)
• protect the graft material in the defect
Guided bone regenerative membranes

22. The Placement Of Immediate Implants With Neither Bone Grafting Nor A
Barrier Membrane Was Also Investigated (Covani Et Al. 2004a).
It Indicated That Circumferential Defects Could Heal Clinically Without
Any GBR And That The Procedure Was Virtually Free From Complications
In The Postoperative Period
Periimplant Defects Of More Than 1.5 Mm Heal By Connective Tissue
Apposition, Rather Than By Direct Bone-to-implant Contact (Wilson Et Al.
1998
For HDD Not Exceeding 1.5mm The Use Of Barrier Membranes Was
Not Necessary, As Long As The Socket Walls Were Intact

23. Buccal Rotated Flap
Becker and Becker (1990)

24. TO CONCLUDE………….
The immediate implant placement approach has been
studied since the1970s
Evidence available today indicated that it is a successful
procedurethat may offer certain benefit to patients.
However, careful planning and case selection are needed to
ensure implant success as well as final esthetic outcomes.
Immediate implants and immediate-delayed implants may offer
some advantages over conventional implants in healed sites in
terms of patient satisfaction and aesthetics possibly by preserving
alveolar bone

25. ITI Treatment Guide volume 3 implant placement in post extraction sites
treatment options
Author : S.CHEN , D.BUSER
Esthetics in implantology,strategies for soft and hard tissue therapy .
Author ;Jose bernardes das neves. 2010
Color atlas of implant surgery
Author: MICHAEL S. BLOCK
Contemporary implant dentistry
Author : CARL .E . MISCH
FUNDAMENTALS OF ESTHETIC
IMPLANT DENTISTRY
Abd El Salam El Askary
REFERENCES

26. The Evaluation of the Success of Immediately Placed Single Implants: A
Retrospective Clinical Study
Bilhan, Hakan; Mumcu, Emre; Geçkili, Onur; Atalay, Belir
Implant Dentistry. 20(3):215-225, June 2011.
Immediate placement of implants into extraction sockets: implant survival
Rosenquist, B; Grenthe, B
Implant Dentistry. 5(4):297, Winter 1996
Simplified Technique for Immediate Implant Insertion into Extraction
Sockets: Report of Technique and Preliminary Results
Fugazzotto, Paul A.
Implant Dentistry. 11(1):79-82, March 2002.
A Technique for Atraumatic Extraction of Teeth Before Immediate Implant
Placement Using Implant Drills
Yalcin, Serhat; Aktas, Irem; Emes, Yusuf; Kaya, Gul; Aybar, Buket; Atalay,
Belir
Implant Dentistry. 18(6):464-472, December 2009.
REFERENCES

27. Immediate Implant Placement Into Fresh Extraction Sites
With Chronic Periapical Pathologic Features Combined With Plasma Rich in
Growth Factors: Preliminary Results of Single-Cohort Study
Massimo Del Fabbro, BSc, PhD,* Cristiano Boggian, DDS,† and Silvio Taschieri,
MD, DDS‡ 009 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 67:2476-2484, 2009
REFERENCES

45. • Furthermore, immediate loading allow improved functional and
aesthetic rehabilitation
• Human studies
• Hermann et al.2007
• Vela-Nebot et al.2006
• Lazzara et al.2006
• Baumgarten et al.2005
• Gardner et al 2005
• Calvo Guirado et al.2007
• FEA studies
• Maeda et al.2008 utilized a 3D finite element model to examine
the biomechanical advantages of platform switching.
• He notes that this procedure shifts the stress concentration away
from the bone-implant interface, but these forces are then
increased in the abutment or the abutment screw

46. • Immediate Placement and Loading of Implants
• Current success of implant therapy
• reevaluation of every aspect of traditional treatment
planning
• assimilate the benefits of osseointegration into clinical
practice
•
• Implants placed immediately after tooth extraction can be as
successful as implants placed into healed sites, with a
success rate of greater than 95% (Gelb 1993, Mensdorf-
Pouilly 1994, Rosenquist 1996,Grunder 1999)