Dental Implants after Tooth Extraction

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.
 

 

 User Comments on -  Dental Implants after Tooth Extraction


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Posted By : Rencey on 19-Nov-2014 12:28 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.
 


Posted By : Roberta Klimas on 10-Jan-2014 10:34 AM
cost for tooth extraction plus implant
 


Posted By : Dr.Ritz on 01-Sep-2012 12:37 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.

 


Posted By : J Susan on 31-Aug-2012 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!
 


Posted By : Dr.Ritz on 20-Aug-2012 09:54 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.

 


Posted By : Jennifer on 20-Aug-2012 08:23 AM
Is it better to have a tooth extracted first and then the implant later or should it all be done at once? I have an appointment for the extraction but they dont do implants so I would have to go somewhere else for the implant. Thank you!
 


Posted By : Emily on 29-May-2012 07:05 PM
Dear Dr. Ritz, Thank you so much for the information and feedback!!! It was very helpful. Kind regards, Emily
 


Posted By : Dr.Ritz on 28-May-2012 10:03 PM
EMILY, 1.) Dental work like tooth extraction is best favorable during 2nd trimester of pregnancy (4th, 5th and 6th month) and you are 5 months pregnant, so there is no harm is going for the dental work. In first trimester there are chances of miscarriage while in third trimester the chances of preterm labor pain increase. Also get suggestion from your physician regarding any other physiological complications of extraction if any. 2.) During second trimester there is no harm of local anesthesia to fetus as lidocaine (main ingredient in LA) has got the tendency to cross the placenta but during first trimester and that too at larger doses. So, the amount of anesthesia injected during tooth extraction is not harmful for the fetus. 3.) Now coming to insertion of a dental implants. Dental implants take atleast 9 months for integration i.e to become a part of your bone. So, though you need get the advise from your physician as implant is an extensive procedure but i would suggest you to get it after delivery. 4.)There are no effects of anesthesia on breast milk...you shouldn't worry at all.
 


Posted By : Emily H on 28-May-2012 07:57 AM
Hello, I have a question. I am currently 23 weeks pregnant (5 months), and due on Oct 1. I have a fractured molar with previous root canal that is causing me a bit of pain. However, baby comes first. 1) Do you recommend waiting for a tooth extraction post-birth? I am concerned with getting an infection at extraction site, and having to take antibiotics, which I would prefer not taking while pregnant. 2) Should you recommend tooth extraction immediately, is it safe to go through the procedure with local anesthesia during pregnancy? What are the main risks for the baby/placenta? 3) When do you recommend tooth implantation? There would be a 4-6 month delay between tooth extraction and tooth implantation. 4) Will anesthesia / medication from tooth implantation affect breastfeeding? Thank you for your feedback!
 


Posted By : Dr.Ritz on 23-May-2012 12:24 AM
LANA MILLER, ideally the implants should be placed immediately after extraction. This is due to the recent success rate of immediate implants. If you can't afford the treatment than you can visit a dental school . There the treatment is very less or may be free depending upon the financial condition.
 


Posted By : Lana Miller on 22-May-2012 04:43 PM
My mentally challenged daughter just had lower front tooth extracted. She doesn't care for teeth, had 2 fillings in it and they broke off. The dentist said she was developing an abscess. She doesn't have money for other restorative work. I am feeling guilty because we had tooth extracted. How much later could we do an implant? Could we wait 6 mos to a year? Thanks!
 


Posted By : Dr. Ritz on 21-Apr-2012 11:48 AM
Julie,normally after the extraction and the bone grafting the dental implants are given after 6 weeks to 3 months. it depends upon many factors so your dentist can tell you theh time you have to wait for the implant
 


Posted By : Julie on 21-Apr-2012 10:47 AM
Due to a cracked tooth (possibly from root canal many years ago), I had a tooth extraction and bone graft on my lower left jaw, both procedures the same day. Approximately how long do I have to wait for dental implant?
 


Posted By : Dr Ritz on 22-Mar-2012 10:45 AM
James, If you are good candidate for tooth implant like if you have good bone density / thickness and the dentist feels that you can go for dental implant then it can be put at any time even if the healing has taken place after tooth fall. So go to your dentist and get yourself evalulated for dental implant.
 


Posted By : James on 21-Mar-2012 10:09 AM
If I had a tooth fall off and is now healed, is it to late for me to get a tooth implant?
 


Posted By : Dr Carl on 20-Jan-2012 03:47 AM

Liza, After tooth extraction, it is important to replace a missing tooth. Missing tooth if not replaced can lead to shifting of adjacent teeth towards missing teeth and can cause supraeruption of teeth of opposing dental arch. Dental implants are the best option for replacement of missing teeth. You can Get one of the top San Diego dental implants dentist to perform your next procedure.

 


Posted By : Liza on 20-Jan-2012 03:46 AM
I got my molar pulled out 1 week ago. It was badly decayed and the dentist said that nothing can be done for the tooth except tooth extraction. I have heard that adjacent teeth start shifting if they are not replaced. So I was planning to get dental implants. Can you suggest me some good implantologist at San diego, California.
 


Posted By : Dr maqbool Ansari on 12-Jan-2012 08:27 AM
I like the articles and cases on the Dental hub .
 


Posted By : Dr Ritz on 06-Oct-2011 11:45 PM
oge, You can get dental implants immediately after tooth extraction or can get them after few weeks (2weeks to 3 months) after tooth extraction or can get them after 3 months after tooth extraction. If there is no infection in the tooth, then dental implants may be given immediately after tooth extraction or can be given after soft tissue healing and bone healing has taken place. If bone resorption has taken place, then bone grafts are given to the patient before or along with placement of dental implants. On the basis of quality and quantity of bone which is left, the dentist will decide when to give dental implants after tooth extraction.
 


Posted By : oge on 06-Oct-2011 01:24 PM
Hi, my lower left 2nd molar got cracked over a month ago. I had a root canal on it some years ago. Now there is an infection at the root of the tooth. I want to extract it and get an implant. How long would you suggest that I wait between extraction and implantation. I've been told that it is best to get the implants as soon as possible after extraction. but i would like to be sure that there is absolutely no infection. Plus i only just had a wisdom tooth extraction and i need a short break from the pain & costs. Also, is there any treatment necessary for the infected root? or is extraction simply enough? I'm presently taking antibiotics as I just had my wisdom tooth extracted. Thanks!
 

 
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