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.
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.
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.
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 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 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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