Welcome to the discussion on immediate implants.
When we have to deal with a lost tooth in the front region,
that normally asks us to place an implant
rather than a conventional bridge,
because with a conventional bridge
we would have to cut preparations in the neighbouring teeth.
So the most biological way of replacing
a missed single tooth is going to be the implant.
Now, if you want to do that
then you want an illusion close to nature
that you create with your treatment
with implant placement and subsequently,
an appropriate prosthetic reconstruction.
In doing that, there is no shooting from the hip,
no show business.
You have to follow the rules of biology.
It is a difficult procedure predominantly
in the area of aesthetic priority.
While it is not so difficult to do
with following a few rules,
you have here an example
where the implant was placed into the extraction socket
and then you have six months later,
everything in blue shows you
addition of bone structures
so it heals nicely into the alveolar socket.
And we're also happy about the appearance
even though here we can criticize
that we have somehow the implant shining through.
But it basically looks at this single tooth replacement
as an illusion close to nature.
Unfortunately this doesn't always stay like that
and that is the warning sign I may use here
because let's say two years later,
we have appearances like that.
Obviously this is unacceptable today
from an aesthetic point of view.
Now, why does this happen?
Is this because we do something wrong
or what is the reason for that?
Well, we have realized that immediate implant placing
has risks and disadvantages.
The implant bed preparation is difficult,
the bone augmentation procedures are normally needed
and primary soft tissue closure is difficult to obtain.
If I want to augment the contours at the same time,
I probably don't have enough soft tissue to cover.
And this is problematic also in infected sites.
Increased risks for facial bone resorption
and consequent soft tissue recession
are the big risks for immediate implant placement.
We have done a systematic review to extrapolate
and find out how much that change
in the dimensions of the alveolar process
is happening within humans.
We conclude that in the hard tissues,
the horizontal resorption that was much more than
the vertical resorption,
that is about 29 to 63% much more than what I just show
for the vertical resorption at six months.
The linear changes vertically are 1 to 1.3 mm
but horizontally, the same resorption
is about 3.8 mm,
showing you how the buccal bone is melting away.
The soft tissue changes only.
There are linear changes there as well.
I want to finish up this presentation
by showing you a study on immediate implants
placed into the extraction socket.
Some of the implants were cylindrical
and others were filling in the alveolus a little bit better
having a tapered design.
60 for the test group and 60 for the control group.
The test group being the tapered implant
and the control group being the parallel design implant.
Now, this study was supposed to last three years.
Now, here you have such a reopening after four months
and you see that all of a sudden
the gaps that were present in the extraction sockets
have disappeared, they are filled up.
Overall, most of the gap was filled with bone
without the need of any grafting material.
And we had significantly greater gap fill
with the cylindrical implants,
not with the conical ones.
There was a significant reduction
in the buccal crest contour of about 33%
and that was more pronounced in the anterior region
when there were thin buccal bony crests
when the patient had a history of periodontitis.
The factors for instance to consider
is the thickness of the bony plate, the buccal plate,
the horizontal position of the implants,
as I said preferably 2 mm
towards the palatal.
The vertical position of the implant,
as I said 1 mm into the socket.
Apical to the crest and finally, smoking habits.
They should be a non-smoker
and the patient should not have had
any history of periodontitis.
These are all the factors
that influence the esthetic outcome.
And in summary, you can see
that this is quite difficult to achieve.
We should choose a conservative approach,
keeping all the tissues
and since an extraction leaves an open space,
we should have this first filled with soft tissue healing.
So, we do generally only type 2 placements today
and use a very standardized protocol in our treatment.
Give the tissues time to heal.
Not everything has to be immediate, immediate, immediate
because the failure may also follow immediate.
To create the perfect illusion,
use a very strict protocol
and observe the factors that influence this healing.
Thank you very much for your attention.
Nikos MattheosClinical Associate Professor in Implant Dentistry
