Immediate dental implants mean that we can remove a tooth and its root, insert the implant and connect a provisional tooth all in the same session. This would be an ideal situation for the dentist and the patient; however, it has its risks in most cases and could expose the implant or even cause it to fail.
At our dental clinic in San Sebastian we will give you information about the indications for this kind of implant and its treatment plan.
Essentially when the tooth to be extracted has not been infected, which is not often the case. It could be applied in the case of a crown fracture, where the root has remained intact.
Added to this, the bone walls around the root must be in perfectly good condition and must not have suffered bone loss. It is important that the vestibular or external wall and its gum are thick.
The process is normally applied to the front teeth, i.e. the incisors, canines or premolars. The molars support too much of a load for this technique. For an immediate implant, not only must the bone be in very good condition, but the tooth extraction and implant placement require a series of special conditions.
Non-traumatic tooth extraction
On extracting the root, the bone walls around it must be kept intact. Care must therefore be taken not to lean on the interproximal bone, which is the one bordering with the adjacent tooth.
This will maintain the triangular gum or papilla existing between two adjacent teeth. If this gum is lost, a series of small dark spaces appears between the teeth; these, if they occur in the top front teeth, can have an adverse aesthetic effect if the patient shows their gums when smiling. If it is a piece with two or more roots, the piece is sectioned to extract the roots one by one and therefore preserve the bone between them.
In the front teeth, access to the screw joining the crown to the implant is preferable from the rear, i.e. from the palate. Hence, when placing the implant in the space left by the root, it must lean against the rear or palate wall, thereby leaving an anterior gap of 2 mm or more.
This anterior gap is filled with artificial bone such as Bio-Oss mixed with growth factors. Thus, in osseointegration, when the anterior bone recedes, it has a certain thickness which prevents implant exposure.
The depth of the post-extraction implant placement is 2 mm with respect to the amelocemental line or limit between the root and the crown of the adjacent teeth. If the implant surface is completely etched, it is placed at 4mm.
Implant classification with respect to the time to have passed since the tooth was extracted
Type I or immediate
This kind of implant is fitted immediately after extraction; it is the procedure described in the previous paragraphs.
Type II or early
This type of implant is fitted 4 to 8 weeks after extraction. This permits healing of the gum closing the gap left by the root, after which we fit the implant together with bone filling and can close the whole socket with the healed gum. The gap on which the work is carried out is the same as in the case of the immediate implant since the bone has not yet been reabsorbed.
This type of implant is fitted 12 to 16 weeks after extraction. This is when most implants are normally fitted since it is the option that offers the best guarantee of good results. By now the bone has been reabsorbed and will remain stable with respect to the implant. There will be no change in bone height, or in the gum.
Type IV or late
This is when we wait for 6 months or more after extraction. This type is applied when, on extracting a tooth, one of the bone walls was destroyed and required regeneration.
To decide when to proceed with the implant, the precise state of the bone must be known prior to extracting the tooth. Today, if gum is lost after implant placement, it can be filled with pink ceramic the same colour of the gum, connected to the white ceramic of the dental crown placed over the implant.