Immediate implants cater to every patient’s ideal dream of obtaining treatment spontaneously. They aim to reduce the patient’s discomfort by being quicker and easier. Implant revolutionizes dental treatment in a way never known before.
The secret of successful implant placements is shared in our series of free online webinars, right at your fingertips. It contains immaculate secrets for quintessential clinical outcomes with a wide range of clinical case documentaries by epitomes in the field.
Pioneers in this field devote implant success to the precise balance of appropriate pre-treatment planning and flawless clinical execution. These implants provide relentless stability, support, and comfort to the patient.
In this lecture given by Dr. Shankar Iyer, he discusses in detail the fundamental principles of immediate implant placement. He provides exemplary insight into the co-relation of theoretical knowledge along with its viable clinical applications.
He initiates the webinar by discussing the foundational physiology of wound healing of the extraction socket. He attributes the success of immediate implants to the correct evaluation of the extraction socket.
He highlights the significance of marrying immediate dental implants to the gums to create the healthiest relationship between them, which lasts forever.
His pointers highlight the need for immediate implants, to enable a clinician to provide the best patient care. He answers the most prevalent question briefly accordingly.
Why Immediate Placement?
1 – Synchronizes the healing of the socket with osseo-integration of the implants due to the presence of growth factors and profuse angio-neogenesis.
2 – Ideal positioning of the implant is indicated.
3 – Eliminates the need for socket grafting.
4 – Expedites treatment time entirely.
5 – Minimises trauma of secondary bone osteotomy
6 – Economical because it eliminates the overall cost of membrane and grafts.
Evidence for Immediate Implant Placement
‘Placement of dental implants at an early timing after tooth extraction
offers advantages in terms of soft and hard tissue preservation, when compared to the famously delayed loading protocol.
Nevertheless, he emphasizes the fact that well-designed, high quality, the randomized clinical trial is needed because the available evidence today is limited in terms of available studies and quality.
Clinical Oral Implants Res 23:2012 67-79
Wound healing is a significant process that dictates the success of an implant fundamentally. This simple socket physiology empowers the clinician to evaluate the clinical success rate of the implant efficiently.
He describes how its important to note the significant milestones of extraction socket healing.
These predominantly include
Day 7 marks soft tissue formation
Day 14 marks the osteoid formation
Day 28 at the time of maturation of newly formed soft and hard tissue.
The greatest fear is that the implant is placed is mush instead of bone, which thereby leads to loss of retention and stability.
Socket preservation is indicated while primary stability is questionable in the implant.
Nuances of socket preservation algorithm for a prosthesis is indicated according to the classification of the extraction socket given by Iyer’s classification.
Iyer’s classification of extraction socket explains the presence and absence of a labial cortical plate for definitive immediate implant placement procedure.
1 – To minimize risk in immediate placement
2- Socket preservation in the aesthetic zone is less than 5%
3- Indications for placement
4- Non-restorable teeth
5- Periodontally compromised teeth with no exudate or esthetic involvement.
6 – Endodontic complications.
7 – Advanced periodontitis
Multirooted situations anatomically computation allows placement of wide-diameter implants. Dr. Shankar Iyer specifies a customized treatment plan for every immediate implant case. He criticizes the abominable placement of implants without a precise patient plan.
In the webinar, he highlights the importance of fundamental criteria for implant placement.
The idealogy of alveolar purchase for extractions without paying heed to the soft tissue surrounding the extraction socket is obsolete.
He emphasizes how minimal buccolingual luxation is indicated for exemplary placement of immediate implants in the socket.
He prophesizes the use of modern cutting edge instruments ranging from the width of 0.5-1mm which are indicated for atraumatic extraction.
The redundancy of the instruments conventionally used for extraction is based on 1681 ‘Pierre Fouchard’ principles of Oral and Maxillofacial Surgery. The armamentarium for extraction has gradually revolutionized to fit in the contemporary need for luxation of extraction sockets.
Dr Shankar Iyer advises the use of
- Luxators (Piezo if available)
Alpha Omegan Protocol and Techniques for Alveolar Bone Preservation is topic which should be thoroughly well-versed for clinicians aiming for Immediate Implants.
Considerations for immediate implant placement :
1 – Availablity of 3 mm bone apical to the apex of the tooth being extracted.
2 – At least 1 mm clearance from adjacent roots
3 – Ability to attain clean granulomatous bed
Contraindications for Immediate Implant placement :
1 – Inablity to achieve complete debridement – Open debridement even with soft tissue underlying the graft
2 – Trajectory of root – Facial plate resorption
Involving placement of implants in the aesthetic zone require controlling the emergence profile of the patient.
Maintaining the facial plate thickness allows the clinician to contour an extremely aesthetic emergence profile.
Along with the principles of placement of immediate implants, many minute aspects of placement should be appreciated.
Placement of immediate implants :
- Anatomic parallelism does not provide prosthodontic parallelism
- Control the osteotomy away from the path of least resistance
- Obtain 30 N of torque in the mandible and 25 N in Maxilla
- Clean aseptic site
Although this article attempts to summarize the beauty of lessons taught Dr. Shankar Iyer in his webinar, the joy of actually seeing his patient case documentation is incomparable. His successful cases have contributed to the smiles of many patients. Hundreds of students have learnt under Dr Shankar Iyer and prospered their practices. Know more about his fellowship programmes collaborated with various institutions in the webinar below.
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