Dental implant is a prosthetic device which is made of alloplastic material and is implanted in the oral tissues either below the mucosal layer or can be placed within the bone to provide support and retention for fixed or removable prosthesis. Dental implants are the best option for replacement of missing teeth.  

For the placement of dental implants, firstly case is selected and then implant is placed in the oral mucosal layer. Dental implant is placed in the bone.  After placing the dental implants, post operative evaluation is done of dental implant and then abutment is attached to it. Abutment is attached when adequate primary stability is obtained. After abutment attachment to the dental implant, dental crown is placed over it.

There are three different approaches to give dental implants after tooth extraction. Dental Implants can either be given-

1.    Immediately after tooth extraction known as immediate post-extraction implant.
2.    2weeks to 3 months after tooth extraction which is known as delayed immediate post extraction implant.
3.    After 3 months or more after tooth extraction which is known as late implantation.

After implant placement, loading is done. Loading can either be done immediately after placement of dental implant or can be done 1 week to 12 weeks after implant placement (Early Loading) or can be done after 3 months of dental implant placement which is known as delayed loading.  

Immediate Post Extraction Dental Implant

In case of immediate post extraction dental implants, Dental implants are given immediately after tooth extraction. Implant placement immediately after tooth extraction followed by immediate provisional restoration can be very rewarding to the patient. Before placing implants after tooth extraction, an implantologist will consider certain factors. There should be adequate bone present all around the implant covering to stabilize the dental implant and there should be no major infections or soft tissue inflammation present. If there is less of bone and grafting procedure is required, then loading is not done immediately after dental implant placement. Immediate provisional restoration is given to the patient if adequate primary stability is obtained after dental implant placement. If there is poor primary stability present, then the implantologist will place the cover screws and will submerge the dental implants. Patient will have to wait for 3-4 months for osseointegration before loading of dental implants.

       

                  Extraction of Fractured Tooth                         Tooth Extraction Socket

             

           Placement of Dental Implant                         Abutment attachment to Dental Implant

         

 Temporary Crown cemented on Implant          Temporary Crown after 1 Month

In cases when there is loss of alveolar bone due to disease, trauma or surgery, then bone grafting procedure may be required. Grafted bone is used as a scaffold to regenerate bone which is lost due to disease, preserve the extraction socket and preserve the ridges. Guided bone regeneration can be done before dental implant placement or can be done simultaneously with dental implant placement.

Various studies suggest that when dental implants are given to single rooted teeth which have healthy bone and mucosa around them, then the success rate is more as compared to delayed implant placement after tooth extraction.

Advantage of Immediate Post Extraction Dental Implant

1.    Reduces the treatment time and surgical steps- Immediate post extraction implantation reduces the number of surgeries and thus is beneficial to both the dentist and the patient.

2.    Preservation of soft tissue drape and bone - If the dental implants are given immediately after tooth extraction, then it preserves the bone which further provides good aesthetic results.

3.    In some situations, it can even result in avoidance of bone augmentation and soft tissue grafts.

Immediate implant placement can be done into extraction socket and provisional restoration can be given to the patient. It has an advantage that it gives immediate esthetics by fixed restoration and reduces the number of surgeries and time required for rehabilitation. It also prevents collapse of peri-implant soft tissues through support given by crafted provisional restoration.

Disadvantages of Immediate Post Extraction Dental Implants

Infections and dental implant failure can occur after immediate placement of dental implants after tooth extraction. After placing dental implant after tooth extraction, there might be some space or gap present between the socket bony walls and dental implant. Bone augmentation procedure is done in such cases.

Delayed Immediate Post Extraction Dental Implants

Delayed immediate post-extraction implants are given 2weeks to 3months after tooth extraction. This is done to allow for soft tissue healing. It further reduces the chances of wound dehiscence but prolongs the treatment time.  It gives a satisfactory aesthetic outcome in patients with thin gingival type. To gain more of bone thickness, bone graft may be used prior to or along with implant placement. After tooth extraction, provisional bridge or an acrylic removable partial denture can be inserted immediately for soft tissue healing to take place. After 8 weeks, you can consult an implantologist. Before placing the dental implants, he will do clinical and radiographic examination. An implantologist may also take 3DCT scan of the extraction site before implant placement. 3DCT scan will give exact dimensions of height, width and depth of the jaw bone.

Late Dental Implantation

Late implantation is given after 3 months or more after tooth extraction. If grafting is not done after tooth extraction, then bone resorption occurs after 3 months and bone becomes stable in 9-12 months. Within 2-3 months after tooth extraction, healing is adequate but bone resorption doesn’t take place.  In case of late implantation, bone replacement membranes and grafts are often needed. Complete bone and soft tissue healing takes place in case of late implant placement. Because of long healing time, vascularization of previously grafted bone takes place. If the ridge is narrow, then guided bone regeneration with an autogenous graft and or connective tissue graft is given prior to or along with implant placement to create contour of the bone and the gingiva. Main drawback of late implantation is that it prolongs the treatment time and needs 2 surgical procedures.

On the basis of quantity and quality of bone left after tooth extraction, dentist will determine whether it would be appropriate to give dental implants immediately after tooth extraction or within 2 weeks to 3 months after tooth extraction or after 3months.
 

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Comments

  • Rencey

    Rencey 19 - November - 2014, at 00:28 AM

  • My daughter has an abscess (this is the third time at same spot). Is it wise to remove abscess, have bone grafting (augmentation)done and have implant (first part) done all at the same time? Due to the fact that this is her third time abscess, should we not rather have the abscess removed and then wait, let's say three months before continuing with the procedure of bone augmentation and implant? Thank you.

  • Roberta Klimas

    Roberta Klimas 10 - January - 2014, at 10:34 AM

  • cost for tooth extraction plus implant

  • Dr.Ritz

    Dr.Ritz 01 - September - 2012, at 00:37 AM

  • Dear J SUSAN, Since you got removed your both the molars so if the wisdom tooth is in normal alignment then i wouldn't recommend for its extraction. But if you are getting implants to replace the two molars then it is better to get it removed as the wisdom tooth might pose a problem in future. And it is very difficult to align wisdom tooth as it requires great deal of time and force plus the results are also not confirmed. So, its better to get implants.

  • J Susan

    J Susan 31 - August - 2012, at 05:02 AM

  • I just had 2 molars removed on the upper left. The wisdom tooth is still there, is that at all advantageous re: tooth implants? I know it's a dumb question but, why would my dentist want to remove the wisdom tooth when theres nothing wrong with it (decay) Also, is there a procedure where a wisdom tooth can be removed and the re-inserted to replace an extracted tooth/teeth? Also if it isnt possible to do that, then what about "maneuvering" it to shift in place of missing teeth? I also have to get another molar extracted on the bottom right. My wisdom tooth on that side is also still there, so the above questions apply to this other tooth as well. I'm disabled and have Medicare plus Medicaid and it doesn't cover implants or dentures. It's upsetting that my health insurance will pay to have teeth pulled but nothing to replace them! Thanks!

  • Dr.Ritz

    Dr.Ritz 20 - August - 2012, at 21:54 PM

  • Dear JENNIFER, Usually after extraction, oral surgeon waits for few months till the extraction socket is completely healed. Waiting for a bit longer time is generally preferred. After that your Xray will be taken to look for the healed bone that can it withstand implants. Then only post implant will be placed. But some surgeons place the bone graft the same day of tooth extraction. Reason being if they will alow the socket to heal, then with due time there will be loss of bone and they might require a lot more of work done for bone graft before the placement of an implant. So, my crux is immediate implants should not be used but if you are in emergency then they can be done on anteriors but don't try immediate implant on posteriors.

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