Implant Placement in Post-Extraction Sites
Treatment Options
Daniel Buser, Daniel Wismeijer, Urs C. Belser, Daniel Buser, Daniel Wismeijer, Urs C. Belser
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Implant Placement in Post-Extraction Sites
Treatment Options
Daniel Buser, Daniel Wismeijer, Urs C. Belser, Daniel Buser, Daniel Wismeijer, Urs C. Belser
Información del libro
This third volume of the ITI Treatment Guide series provides clinicians with practical clinical information that will allow them to make evidence-based decisions regarding appropriate implant placement protocol in post-extraction sockets. The book features 15 case presentations illustrating the use of various clinical protocols as well as discussion of the factors influential to treatment outcome and potential complications.Implant dentistry has become a standard option for the rehabilitation of fully and partially edentulous patients. With the ever-increasing number of dentists involved in implant dentistry, it is essential to ensure that their treatment methods follow the highest standard. The ITI Treatment Guide series, a compendium of evidence-based implant-therapy techniques in daily practice, is written by renowned clinicians and provides a comprehensive overview of various therapeutic options. Using an illustrated step-by-step approach, the ITI Treatment Guide shows practitioners how to manage different clinical situations, with the emphasis on sound diagnostics, evidence-based treatment concepts, and predictable treatment outcomes.
Preguntas frecuentes
Información
1 Introduction
S. Chen, D. Buser
2 Proceedings of the Third ITI Consensus Conference: Implants in Post-Extraction Sites
Gil Alcoforado
Jay R. Beagle
Jean-Pierre Bernard
Stephen T. Chen
Anthony Dickinson
Paul Fugazzotto
Erik Hjørting-Hansen
Louis Antonio Lima
Jan Lindhe
Thomas Oates
Mario Roccuzzo
James Ruskin
Thomas von Arx
Gerhard Wahl
Thomas G. Wilson Jr.
2.1 Consensus Statements and Recommended Clinical Procedures Regarding the Placement of Implants in Post-Extraction Sites
- Stephen T. Chen, Thomas G. Wilson Jr., and Christoph H. F. Hämmerle: “Immediate or Early Placement of Implants Following Tooth Extraction: Review of Biologic Basis, Clinical Procedures, and Outcomes” (Chen and coworkers, 2004)
2.1.1 Consensus Statements
Socket HealingResults of clinical, radiologic, and histologic studies indicate that bony healing of extraction sites proceeds with external resorption of the original socket walls and a varying degree of bone fill within the socket.
Bone RegenerationStudies in humans and animals have demonstrated that at implant sites with a horizontal defect dimension (HDD; i.e. the peri-implant space) of 2 mm or less, spontaneous bone healing and osseointegration of implants with a rough titanium surface takes place.In sites with HDDs larger than 2 mm and or non-intact socket walls, techniques utilizing barrier membranes and/or membrane-supporting materials have been shown to be effective in regenerating bone and allowing osseointegration.Although scarce, the majority of the comparative data regarding the success of bone regeneration at peri-implant defects suggests no differences between Type 1, 2, and 3 procedures.Further comparative analyses of different methods of bone augmentation with regard to successful bone formation and stability over time are required.Long-term analysis of the stability of the regenerated bone is focused almost exclusively on radiographic assessments of the interproximal bone and implant survival. There is a need for studies to evaluate the fate of the buccal bone plate – whether regenerated or not – over time.
Adjunctive MedicationIn most studies reviewed, broad-spectrum systemic antibiotics were used in conjunction with implant placement Type 1, 2, and 3. Controlled studies evaluating the effect of systemic antibiotics on treatment outcomes are needed.
Survival of ImplantsThe survival rate of immediately placed implants (Type 1) was reported in numerous studies to be similar to that of implants placed into healed ridges (Type 4).In the few studies available, short-term survival rates of implants placed in conjunction with Type 2 and 3 procedures appear similar to those placed in Type 1 and 4 approaches.There have been relatively few reports on the subject of Type 2 and 3 implant procedures, and only 2 of them were randomized with respect to timing of placement and augmentation methods used. Longitudinal studies of greater than 3 years’ duration were limited to 2 reports.There is evidence to suggest that the survival rate for implants placed immediately following extraction of teeth associated with local pathology is similar to that of implants placed into healed ridges. Further controlled studies are required to provide definitive information about the management of these situations.
Esthetic OutcomesEsthetically pleasing treatment outcomes have received considerable attention in recent years; however, there are no controlled studies available on esthetic treatment outcomes in Type 1, 2, and 3 procedures.
2.1.2 Proposed Clinical Approaches
Patient AssessmentAll candidates for extraction-site implants should meet the same general screening criteria as regular implant patients, regardless of the timing of implant placement.
AntibioticsThe literature is inconclusive regarding antibiotic use in conjunction with implant therapy. There is general agreement that the use of antibiotics is advantageous when augmentation procedures are performed.
Tooth ExtractionExtraction techniques that result in minimal trauma to hard and soft tissue should be used. The sectioning of multi-rooted teeth is advised. All granulation tissue should be removed from the socket.
Site EvaluationSite evaluation is critical to the determination of appropriate treatment modalities. Factors of concern include:
Overall patient treatment plan Esthetic expectations of the patient Soft tissue quality, quantity, and morphology Bone quality, quantity, and morphology Presence of pathology Condition of adjacent teeth and supporting structures
Primary Implant StabilityThe implant should not be placed at the time of tooth removal if the residual ridge morphology precludes attainment of primary stability of an appropriately sized implant in an ideal restorative position.
Thin BiotypeWhen treating patients with a thin, scalloped tissue biotype – even those with an intact buccal plate – concomitant augmentation therapies at the time of implant placement (Type 1) are recommended because of the high risk of buccal plate resorption and marginal tissue recession.If buccal plate integrity is lost, implant placement is not recommended at the time of tooth removal. Rather, augmentation therapy is performed, and a Type 3 or 4 approach is utilized.
Thick BiotypeIn cases involving a thicker, less scalloped tissue bio-type with an intact buccal plate, the need for concomitant augmentation therapies at the time of implant placement (Type 1) may be reduced, since thick bio-types have a decreased risk of buccal-plate resorption in comparison with thinner biotypes. As buccal-plate integrity is lost, the need for augmentation therapies increases.When the buccal plate is compromised, negatively impacting the predictability of treatment outcomes, immediate (Type 1) implant placement is not indicated; rather, a Type 2, 3 or 4 procedure is carried out. When the HDD is greater than 2 mm, concomitant augmentation therapy needs to be performed.Adjunctive augmentation therapies may be indicated in any of the above situations to optimize esthetic treatment outcome.
Implant PlacementThe three-dimensional positioning of the implant should be restoratively driven.