The document discusses immediate implant placement and restoration in the anterior maxilla. It notes that while survival rates of immediate implants are high, there is usually loss of buccal bone and soft tissue recession over time. Immediate provisional restoration of implants can help preserve the buccal bone and soft tissues. For best outcomes with immediate anterior implants, the patient should have adequate bone volume and thick soft tissues.

1. Implantology in the 21st century

2. theory cases

3. 1. Chiche GJ, Pinault A. Esthetics of Anterior Fixed Prosthodontics. 1st ed1994, Chicago: Quintessence.
2. Goldstein R. Change your smile. 3rd ed 1997, Chicago: Quintessence.
3. Fradiani M et al., Esthetic Rehabilitation in Fixed Prosthodontics. 2004, London: Quintessence.
4. Magne P, Belser U. Natural oral esthetics. In: Bonded porcelain restorations in the anterior dentition: a biomimetic approach. 1st ed 2002, Chicago:
Quintessence.
5. Donitza A et al. 2008 Creating the perfect smile: prosthetic considerations and procedures for optimal dentofacial esthetics. J Calif Dent Assoc 36:335-
340, 342.
6. Wolfart S et al., 2006 Subjective and objective perception of upper incisors. J Oral Rehabil 33:489-495.
75
%
1,6
2
1 :
0,23 : 0,62 :

4. 1. Chiche GJ, Pinault A. Esthetics of Anterior Fixed Prosthodontics. 1st ed1994, Chicago: Quintessence.
2. Fradeani M et al. Esthetic Rehabilitation in Fixed Prosthodontics. 2004, London: Quintessence.
3. Magne P, Belser U. Natural oral esthetics. In: Bonded porcelain restorations in the anterior dentition: a biomimetic approach. 1st ed 2002, Chicago:
Quintessence.

5. Mehl et al. (2018) - Effect of ultraviolet photofunctionalization of dental
titanium implants on osseointegration. JZ hejiang Univ - Science B

6. Mehl et al. 2018 - Effect of ultraviolet photofunctionalization of dental titanium implants on
osseointegration. Journal of Zhejiang University Science B

7. The development of a concept over the past 15 years

8. What do we need to create new bone?

9. blood supply
What do we need to create new bone?

10. no movement
blood supply
What do we need to create new bone?

11. no movement
blood supply
no infection
What do we need to create new bone?

12. blood supply
no infection time
What do we need to create new bone?
no movement

13. Clinical case
Bone substitute and sandwich osteoplastic

20. Chirurgie Prof. Terheyden

24. Tiefziehschiene
Abformung für
Provisorium

31. Recall 7 years

32. Recall 8 years

33. Placement Recall 8 years

34. X-ray 8 years

35. X-ray 8 years

36. Pre-implant phase – 3 months
Bone augmentation – 4 months
Implant – 3 months
Exposure – 1 months
Prosthodontics – 1 weeks
Overall time –12 months

37. Clinical case
Old school - molar region

47. Bone Block – 4 month
Implant – 3 month
Exposure – 1 month
Prosthodontics – 2 weeks
Overall time – 8.5 month

48. Clinical case
Old school - anterior region

66. Bone block – 5 months
Implant – 3 months
Temporary – 3 months
Prosthodontics – 1 months
Overall time – 12 months

67. Clinical case
Single implant anterior region – old school

80. Placement Finish

81. Extraction/Temp – 3 month
Implant – 3 month
Temporary – 3 month
Prosthodontics – 1 month
Overall time – 10 month
Imperfect aesthetic results
That is not going to be good enough!

82. This takes too long – alternatives?

83. Why not placing the implant and do the bone augmentation simultaneously?

84. Science - immediate implants posterior

85. Science
- Since the 1970s
- Osseointegration histologically proven
- No review or prospective studies
- Survival rates between 97% und 100%
- Bone remodelling happens with or without implants 4-12 weeks after
extraction
- Infections not relevant
- Thickness of the buccal plate reduces 50%
- Buccal gap should be filled - reduces resorbtion
- Changes in the vertical dimension depended on thickness of the buccal
plate
1. Paolantonio M., Dolci M., Scarano A., d’Archivio D., Placido G.D., Tumini V., Piattelli A. Immediate implantation in fresh extraction sockets. A controlled clinical and histological study in man. J.
Periodontol. 2001
2. Donati M., Botticelli D., La Scala V., Tomasi C., Berglundh T. Effect of immediate functional loading on osseointegration of implants used for single tooth replacement. A human histological
study. Clin. Oral Implants Res. 2013;24:738–745. doi: 10.1111/j.1600-0501.2012.02479.x.
3. Watzek G., Haider R., Mensdorff-Pouilly N., Haas R. Immediate and delayed implantation for complete restoration of the jaw following extraction of all residual teeth: A retrospective study
comparing different types of serial immediate implantation. Int. J. Oral Maxillofac. Implants. 1995;10:561–567.
4. Anitua E., Piñas L., Alkhraisat M.H. Long-Term Outcomes of Immediate Implant Placement into Infected Sockets in Association with Immediate Loading: A Retrospective Cohort Study. J.
Periodontol. 2016;13:1–15. doi: 10.1902/jop.2016.160104.
5. Kolerman R., Nissan J., Rahmanov A., Zenziper E., Slutzkey S., Tal H. Radiological and Biological Assessment of Immediately Restored Anterior Maxillary Implants Combined with GBR and Free
Connective Tissue Graft. Clin. Implant Dent. Relat. Res. 2016 doi: 10.1111/cid.12417.
6. Kan J.Y., Rungcharassaeng K., Lozada J. Immediate placement and provisionalization of maxillary anterior single implants: 1-year prospective study. Int. J. Oral Maxillofac. Implants. 2002;18:31–
39.

86. What should you be aware of?
Thick and intact buccal bone wall
Thick gingival biotype (CTG)
Minimal trauma in tooth extraction
Presence of at least 3 socket walls — ideally 4 walls
Implant shoulder should be placed 2–3 mm apical to anticipated gingival
margin
If buccal plate thin à 2 mm below alveolar crest
If buccal plate thick à 1 mm below alveolar crest
Primary implant stability with engagement of 3–4 mm bone apical to root
apex (45 Ncm)
Slight palatal/lingual positioning of implant
Fill the gap between implant and inner bone surface using a low resorbing
bone graft material with or without membrane

87. What should you be aware of?
Thick and intact buccal bone wall?
Thick gingival biotype (CTG)
Minimal trauma in tooth extraction
Presence of at least 3 socket walls — ideally 4 walls
Implant shoulder should be placed 2–3 mm apical to anticipated gingival
margin
If buccal plate thin à 2 mm below alveolar crest
If buccal plate thick à 1 mm below alveolar crest
Primary implant stability with engagement of 3–4 mm bone apical to root
apex (45 Ncm)
Slight palatal/lingual positioning of implant
Fill the gap between implant and inner bone surface using a low resorbing
bone graft material with or without membrane

88. 1. Bone loss after tooth extraction is unfortunately unavoidable
2. After tooth extractions alveolar changes often force the clinician to replace the
missing bone
3. Implant placement in an edentulous region without the bony augmentation
of
the implant site can lead to an esthetic disaster
Araujo et al., 2006, Nevins et al., 2006, Qahash et al., 2008, Tan et al., 2012, Tan et al., 2004,

100. Implant placement and bone augmentation simultaneously!
But lets test it first in the molar/premolar region!

101. Clinical case
Single Implant – simple – immediate restoration

118. Xla/Implant/Temporary – 3 month
Prosthodontics – 1 month
Overall time – 4 month
Good aesthetic results, but time still too long!
That is not going to be good enough!

119. Clinical case
Camlog progressive – immediate placement and restoration

141. Extraction/Temp – 2 weeks
Prosthodontics – 1.5 weeks
Overall time – 3.5 weeks
We are getting better!
But is it reliable?

142. Clinical case
Camlog progressive – immediate placement and restoration 2

154. Extraction/Temp – 2 weeks
Prosthodontics – 2 weeks
Overall time – 4 weeks
It seems to be reliable!
But before we apply this technique to the front

155. Now to the anterior region!

156. Science – hard tissue
- Implant survival 97% immediate implantation
- Implant survival 98% late implantation
- Bone remodelling happens with or without implantation 4-12 weeks
after extraction
- Infections do not play a role
- Buccal plate reduced 50%
- Fill the buccal gap
- Vertical changes depending on the thickness of the buccal plate
1. den Hartog, L., et al., Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction. J Clin Periodontol, 2008. 35(12): p.
1073-86.
2. Slagter, K.W., et al., Immediate placement of dental implants in the esthetic zone: a systematic review and pooled analysis. J Periodontol, 2014. 85(7): p. e241-50.
3. Weigl, P. and A. Strangio, The impact of immediately placed and restored single-tooth implants on hard and soft tissues in the anterior maxilla. Eur J Oral Implantol, 2016. 9 Suppl 1: p. S89-106.
4. 3. Chen S.T., Darby I.B., Reynolds E.C. A prospective clinical study of non-submerged immediate implants: Clinical outcomes and esthetic results. Clin. Oral Implants Res. 2007;18:552–562. doi: 10.1111/j.1600-0501.2007.01388.x.
5. Kolerman R., Nissan J., Rahmanov A., Zenziper E., Slutzkey S., Tal H. Radiological and Biological Assessment of Immediately Restored Anterior Maxillary Implants Combined with GBR and Free Connective Tissue Graft. Clin. Implant Dent. Relat. Res. 2016
doi: 10.1111/cid.12417.
6. Kan J.Y., Rungcharassaeng K., Lozada J. Immediate placement and provisionalization of maxillary anterior single implants: 1-year prospective study. Int. J. Oral Maxillofac. Implants. 2002;18:31–39.
7. Romão M., Marques M., Cortes A., Horliana A., Moreira M., Lascala C. Micro-computed tomography and histomorphometric analysis of human alveolar bone repair induced by laser phototherapy: A pilot study. Int. J. Oral Maxillofac. Surg. 2015;44:1521–
1528. doi: 10.1016/j.ijom.2015.08.989.
8. Lang N.P., Pun L., Lau K.Y., Li K.Y., Wong M. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Clin. Oral Implants Res. 2012;23:39–66. doi: 10.1111/j.1600-
0501.2011.02372.x.
9. Bianchi A.E., Sanfilippo F. Single-tooth replacement by immediate implant and connective tissue graft: A 1–9-year clinical evaluation. Clin. Oral Implants Res. 2004;15:269–277. doi: 10.1111/j.1600-0501.2004.01020.x.
10. Canullo L., Iurlaro G., Iannello G. Double-blind randomized controlled trial study on post-extraction immediately restored implants using the switching platform concept: Soft tissue response. Preliminary report. Clin. Oral Implants Res. 2009;20:414–420.
doi: 10.1111/j.1600-0501.2008.01660.x.
11. Lee C., Tao C., Stoupel J. The Effect of Subepithelial Connective Tissue Graft Placement on Esthetic Outcomes Following Immediate Implant Placement: Systematic Review. J. Periodontol. 2016;87:156–167. doi: 10.1902/jop.2015.150383.
12. Saito H., Chu S.J., Reynolds M.A., Tarnow D.P. Provisional Restorations Used in Immediate Implant Placement Provide a Platform to Promote Peri-implant Soft Tissue Healing: A Pilot Study. Int. J. Periodontics Restor. Dent. 2016;36:47–52.
13. Bruno V., O’Sullivan D., Badino M., Catapano S. Preserving soft tissue after placing implants in fresh extraction sockets in the maxillary esthetic zone and a prosthetic template for interim crown fabrication: A prospective study. J. Prosthet.
Dent. 2014;111:195–202. doi: 10.1016/j.prosdent.2013.09.008.
14. Bruno V., Badino M., Sacco R., Catapano S. The use of a prosthetic template to maintain the papilla in the esthetic zone for immediate implant placement by means of a radiographic procedure. J. Prosthet. Dent. 2012;108:394–397. doi: 10.1016/S0022-
3913(12)60199-1.

157. Science – soft tissue
- After 3 years always loss of 1 mm gingiva vertically
- Recession risk 17% if implant placed palatally
- Recession risk 60% if implantat placed to far buccally!!
- CTG stops recession, but also studies stating the opposite
à Thin gingival type à CTG!
- If we place a implant supported temporary we have better soft tissue
healing and buccal bone is kept better
à Temporary!
1. den Hartog, L., et al., Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction. J Clin Periodontol, 2008. 35(12): p.
1073-86.
2. Slagter, K.W., et al., Immediate placement of dental implants in the esthetic zone: a systematic review and pooled analysis. J Periodontol, 2014. 85(7): p. e241-50.
3. Weigl, P. and A. Strangio, The impact of immediately placed and restored single-tooth implants on hard and soft tissues in the anterior maxilla. Eur J Oral Implantol, 2016. 9 Suppl 1: p. S89-106.
4. 3. Chen S.T., Darby I.B., Reynolds E.C. A prospective clinical study of non-submerged immediate implants: Clinical outcomes and esthetic results. Clin. Oral Implants Res. 2007;18:552–562. doi: 10.1111/j.1600-0501.2007.01388.x.
5. Kolerman R., Nissan J., Rahmanov A., Zenziper E., Slutzkey S., Tal H. Radiological and Biological Assessment of Immediately Restored Anterior Maxillary Implants Combined with GBR and Free Connective Tissue Graft. Clin. Implant Dent. Relat. Res. 2016
doi: 10.1111/cid.12417.
6. Kan J.Y., Rungcharassaeng K., Lozada J. Immediate placement and provisionalization of maxillary anterior single implants: 1-year prospective study. Int. J. Oral Maxillofac. Implants. 2002;18:31–39.
7. Romão M., Marques M., Cortes A., Horliana A., Moreira M., Lascala C. Micro-computed tomography and histomorphometric analysis of human alveolar bone repair induced by laser phototherapy: A pilot study. Int. J. Oral Maxillofac. Surg. 2015;44:1521–
1528. doi: 10.1016/j.ijom.2015.08.989.
8. Lang N.P., Pun L., Lau K.Y., Li K.Y., Wong M. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Clin. Oral Implants Res. 2012;23:39–66. doi: 10.1111/j.1600-
0501.2011.02372.x.
9. Bianchi A.E., Sanfilippo F. Single-tooth replacement by immediate implant and connective tissue graft: A 1–9-year clinical evaluation. Clin. Oral Implants Res. 2004;15:269–277. doi: 10.1111/j.1600-0501.2004.01020.x.
10. Canullo L., Iurlaro G., Iannello G. Double-blind randomized controlled trial study on post-extraction immediately restored implants using the switching platform concept: Soft tissue response. Preliminary report. Clin. Oral Implants Res. 2009;20:414–420.
doi: 10.1111/j.1600-0501.2008.01660.x.
11. Lee C., Tao C., Stoupel J. The Effect of Subepithelial Connective Tissue Graft Placement on Esthetic Outcomes Following Immediate Implant Placement: Systematic Review. J. Periodontol. 2016;87:156–167. doi: 10.1902/jop.2015.150383.
12. Saito H., Chu S.J., Reynolds M.A., Tarnow D.P. Provisional Restorations Used in Immediate Implant Placement Provide a Platform to Promote Peri-implant Soft Tissue Healing: A Pilot Study. Int. J. Periodontics Restor. Dent. 2016;36:47–52.
13. Bruno V., O’Sullivan D., Badino M., Catapano S. Preserving soft tissue after placing implants in fresh extraction sockets in the maxillary esthetic zone and a prosthetic template for interim crown fabrication: A prospective study. J. Prosthet.
Dent. 2014;111:195–202. doi: 10.1016/j.prosdent.2013.09.008.
14. Bruno V., Badino M., Sacco R., Catapano S. The use of a prosthetic template to maintain the papilla in the esthetic zone for immediate implant placement by means of a radiographic procedure. J. Prosthet. Dent. 2012;108:394–397. doi: 10.1016/S0022-
3913(12)60199-1.

158. What should you be aware of?
Thick and Intact Buccal Bone Wall
Thick gingival biotype (CTG)
Minimal trauma in tooth extraction
Presence of at least 3 socket walls — ideally 4 walls
Implant shoulder should be placed 2–3 mm apical to anticipated gingival margin
If buccal plate thin à 2 mm below alveolar crest
If buccal plate thick à 1 mm below alveolar crest
Primary implant stability with engagement of 3–4 mm bone apical to root apex (45 Ncm)
Slight oral positioning of implant
Fill the gap between implant and inner bone surface using a low resorbing bone graft material with or without membrane
Temporary
If thin gingival type à CTG

159. Clinical cases
Some more immediate implants - simple

168. Clinical cases
Some more immediate implants - advanced

208. Clinical cases
Some more immediate implants – complex

223. P l a c e m e n t R e c a l l 4 y e a r s

224. Clinical cases
Some more immediate implants - crazy

244. P l a c e m e n t R e c a l l 2 y e a r s

245. Clinical case
Camlog progressive – modern standard

270. Klinischer Fall
Full arch cases

271. m a d e b y

297. Clinical case
Camlog progressive – Comfour case 1 – the modern standard

336. Recall one year

339. Clinical case
Camlog progressive – Comfour case 2

364. Clinical case
Camlog progressive – Comfour case 1 – the modern standard

374. Vielen Dank für die Aufmerksamkeit
-
Bis gleich beim gemeinsamen
Abendessen
Vielen Dank!