Immediate dental implants.

1. Immediate Dental Implant

2. Immediate Dental implant
• Dr. Shaymaa Hussein Rafat Kotb
• Master degree in oral Medicine ,periodontology ,Alazhar university.
• M RCSI, RCSEng ,RCSEd , RCPSG

3. Outlines
• Introduction
• Types od Dental implants
• Aim of therapy
• Selection of patients
• Inclusion crieteria
• Exclusion crieteria
• Guidlines for every step in implant placement
• Advantages
• Disadvantages
• Case Report
• Results
• Recommendation
• References

4. Introduction
• Implant dentistry has become increasingly important in oral
reconstruction since the intra-oral use of titanium implants in
late 1950 .
• The philosophy behind successful implant restoration became
known as restoration driven implant placement
• Many factors should be considered to obtain a successful
implant such as patient selection ,surgical technique ,ideal
placement and osseointegration .
• Treatment planning decision can be conducted through
interpretation cone beam computarized tomography CT.

5. Dental Implant
• Dental Implant Defined as “ a prosthetic device
implanted into the oral tissues beneath or within the bone
to provide retention and support for final prosthesis .
• Dental Implant : has emerged as a novel rehabilitation
option for missing teeth in last two decades
• Dental implants remain the most reliable ,functional
,aesthetics alternative compared to traditional used
prosthetics appliances

6. Dental Implant
Modern implant dentistry aims at improving
patient masticatory function, aesthetics,and overall
quality of life. Dental implants achieve these aims
via the concept of osseointegration.
In 1969, Per-Ingvar Branemark described
osseointegration as “a direct structural and
functional connection between ordered living bone
and the surface of the load-covering implant”

7. Types of Denatl implants
Immediate
implants
In fresh
extracted
socket
At time of
extraction
Delayed
implants
In healed
socket
After 8
weeks or
more

8. Types of Dental implants
Immediate
implants
Natural look
since first day
No bone surgery
needed
Delayed
implants
Can,t restore
natural look until
crown inserted 6
months later
Need
bone,gingival
displacement
surgery

9. Dental implant
The success of dental implant directly related to
patient evaluation :
 Medical History
Dental History
Radiographic Evaluation
precious Diagnosis and treatment planning result in
excellent outcomes .

10. Aim OF study
• To thorough the light on the Advantages,
disadvantages of immediate dental
implant in restoring the normal function,
aesthetics, speech at the same time of
extraction the tooth

11. Patient and Method
Clinical Diagnosis
Radiographic Interpretation
Treatment plan

12. Patient and Method:
Selection of Patients
• Diagnosis : correct diagnosis result in proper treatment plan and
consequent long term prognosis
• Medical History : ( Absolute containdicated )avoid
immunosuppression ,bleeding problems ,drug abuse ,bisphosphonate
drugs
• Relative contraindications: adolescent ,osteoprosis ,smoking
,uncontrolled diabetes .
• Dental History : Gingival phenotype ,Periodontal examiniation
include soft &hard tissues supporting structure.)
• Occlusal analysis is mandatory to avoid failure
• Radiographic examination : CBCT& 3D imaging show
reformatting images of bone quality and quantity at each desires
surgical plan ,bone width & bone hight .

13. Selection criteria
• Inclusion criteria:
• the tooth being extracted due to endodontic
involvement, root fracture, root resorption, periapical
pathology , root perforation, or unfavorable crown-to-
root ratio.
• Atraumatic extraction procedure

14. Exclusion criteria
• Smokers
• Pregnant ,lactated female patients
• Patients with parafunctional habits such as bruxism
• Perforation of alveolar bone following tooth removal
• Patient with comporomised diseases condition
• Inability to achieve primary implant stability following
implant placement

15. Guidelines for every step
in implant placement
• Necessary to extract with no or little disturbances to
surrounding bone as possible.
• Using periotome for traumatic extraction is the key for
immediate implant success
• Immediate implant refer to placement of implants into
fresh extraction sockets immediately after extraction
• Selecting the proper implant size allow to remain stable
in position
• Flapless surgery

16. Advantages of immediate
implant vs standard implants
Patient acceptability
Placed at the same time after tooth extraction
Flapless technique so no need for bone carving or gum
displacement
Without stitches
Reduce patient discomfort & pain
Natural profile for your tooth & soft tissues from the first
day
Few clinic visit
Cost effectiveness

17. Limitation make immediate
implants not applicable at
time
Infection at implant site
Thin gingival phenotype
Sever periodontal diseases
No enough bone (fenestration ,Dehescence)
Proximity to vital structure(max sinus)

18. Disadvantages of
Immediate implants
Technically need Expert operator
Lack of control on final implant position
Increase possibility of infection
Difficult primary stability
Inadequate soft tissue coverage
Difficulty in preparing the osteotomy due to bur
movement along the extraction site walls
The additional cost of bone grafting.

19. Case report
 32-year-old female, who was clinically fit (no systemic disease),
and did not present bruxism ,presented to the Department of Oral
and Maxillofacial Surgery at Alazhar university 2020.
 The patient’s main complaint involved fractured maxillary second
premolar with total loss of two third of crown structures—#15—that
had suffered recent prosthetic losses, thus rendering the patient
functionally and aesthetically impaired.
 Medical data and complementary examinations confirmed normal
health conditions.
 Cone Beam Computed Tomography(CBCT) confirmed the clinical
findings of tooth no#15 having extensive caries .
 The patient gave his informed consent to publish the details of the
case and any accompanying images.

20. Radiographic Examination

21. Clinical photograph
showing badly
destructed tooth

22. Clinical photograph
showing Minimal invasive
Surgical extraction

23. Clinical photo showing
Implant placement
procedure

24. Healing abutment

25. Final restoration

26. postoperative X-ray
after placement final
restoration (6 months
later).

27. Results
The results were highly satisfactory and approved by
the patient. The patient was followed-up monthly for the
next 12 months, wherein we assessed :
the implants’ stability,
 possible bone loss,
gingival health,
and aesthetic conditions were also assessed .

28. Results
No signs or symptoms of pain, tenderness, redness or
inflammation of soft tissue around the inserted
implant site throughout the study
No signs of infection, gingivitis or peri-implantitis at
follow up periods.
Excellent result of osseointegration between bone and
implant surface
Overall Survival rates : 95%

29. Results
 Correct planning ,
 Precise manipulation of soft tissues
The use of new technologies associated with
planning of surgical technique.
 By following these guidelines: grant the patient
acceptance and Positive excellent results in
regards to clinical, radiographic and aesthetics
outcomes of implant survival and minimal changes in
soft & hard tissues around immediate implants

30. Conclusions
Placement of dental implants into fresh
extraction sockets has major advantages
over delayed placement,(such as):
 Reduced overall treatment time
Reduce the number of surgical procedures ,
Reduce patient discomfort
Increase patient acceptance

31. Conclusion
without adequate oral health control as presented in
this clinical case, the chances of developing peri-implant
mucositis are very high, and may lead to aesthetic and
functional failure.

32. Recommendation
Advice patient of meticulous oral hygiene
Advice about using antiseptic mouthwash
Advice patient about followup at regular interval
Advice patient ,if he feel any abnormal symptoms should
consult with his dentist quickly .
Advice patient to eat healthy diet (riched with vegetables
and fruits)

33. References
 Block, M.S. Dental Implants: The Last 100 Years. J. Oral Maxillofac. Surg. 2018, 76, 11–
26.
 Cosyn, J.; De Lat, L.; Seyssens, L.; Doornewaard, R.; Deschepper, E.; Vervaeke, S. The
effectiveness of immediate implant placement for single tooth replacement compared to
delayed implant placement: A systematic review and meta-analysis. J. Clin. Periodontol.
2019, 46, 224–241.
 Báez-Marrero, N.; Rafel, J.L.; Rodríguez-Cárdenas, Y.A.; Aliaga-Del Castillo, A.; Dias-
Da Silveira, H.L.; Arriola-Guillén, L.E.Accuracy of computer-assisted surgery in
immediate implant placement: An experimental study.J. Indian Soc. Periodontol.2022 ,26,
219–223
 Tonetti, M.S., Cortellini, P., Graziani, F et al. Immediate versus delayed implant
placement afteranterior single tooth extraction: the timing randomised controlled clinical
trial. Journal of ClinicalPeriodontology 2017; 44, 215–224.
 Lang, N.P., Pun, L., Lau, K.Y., Li, K.Y. & Wong, M.C. A systematic review on survival
and successrates of implants placed immediately into fresh extraction sockets after at least 1
year. Clinical Oral Implants Research 2012; 23(5), 39–66
 Botticelli D, Renzi A, Lindhe J, Berglundh T. Implants in fresh extraction sockets: a
prospective 5-year follow-up clinical study. Clin Oral Implants 2008;19(12):1226-32.

34. Thank you
Dr. Shaymaa Hussein Rafat Kotb
 Master degree in oral Medicine ,periodontology ,Alazhar university
 M RCSI , RCSEng , RCSEd , RCPSG