Predictable Immediate Implant Esthetics
The following cases illustrate a predictable method for achieving predictable immediate implant esthetics.
The implant is placed, grafted with Immediate Graft, and a healing abutment is placed level with the gingival margin.
Finger pressure is used to compress the gingiva against the healing abutment and Oral Bond is applied. The hex driver slot if filled with teflon tape before bonding in order to facilitate healing abutment removal.
Immediate Implant Placement: Step by Step
The following case is a step by step process of how to achieve the new immediate implant placement.
Immediate Graft is used to graft the site. The material is frozen. Cover the graft and use a spatula to break off pieces of the graft.
What are the critical factors for success of this immediate implant method and why does this method produce superior bone and esthetic results? There are two main factors one is the graft and the other is the application of Oral Bond.
For long term success, bone must form in the area of the graft and the bone must integrate to the surface of the implant. If no graft is used, the defect may appear to fill with bone, but the bone will not integrate to the implant surface. Also, if cadaver bone is used, the defect will appear to filled with bone, but again the bone will not integrate to the surface of the implant. This has been proven by a study done by Becker and Urist from USC:
Histologic findings after implantation and evaluation of different grafting materials and titanium micro screws into extraction sockets: case reports
The study found that allografts, xenografts, and autografts all failed to produce integration to the implant surface.
Most dentists don’t care because the post op radiograph looks good. However, they should care because a study of a very large patient pool found that when an immediate implant is grafted with cadaver and autografts, marginal bone loss occurs progressively over time:
- Immediate implants in the esthetic zone grafted with Immediate Graft with a healing abutment bonded with Oral Bond.
- When immediate implants are not possible in the esthetic zone but with all walls in place, implants are placed 4 weeks post extraction.
- Bicuspids: Graft with Socket Graft with implants placed 4 weeks post extraction.
- Molars: Graft with Socket Graft with implant placed 6 weeks after extraction.
- When socket walls are missing, graft with Socket Graft Plus and place implants in 3 months.