There are different approaches to placement of dental implants after tooth extraction. These approaches can be categorised into:
- Immediate post-extraction implant placement.
- Late implantation (three months or more after tooth extraction).
The timing of dental implants placement after extraction of teeth varies from individuals and are affected by a variety of factors. Immediate placement of dental implants at the time of extraction has become more popular in recent years however not everyone is suitable for immediate implant placement even though this method has the advantage of minimising the treatment time. This is usually dependent on various factors such as the quality and quantity of the jaw bone, bite force that the teeth have to absorb, the gum bio-type and the type of implant used.
Infection around the implant area is also a factor that can influence whether an implant is placed at the time of the extraction. Clinicians need to ensure that the tissues in the areas in which the implants are to be placed need to be free of infective tissue to minimise the risk of rejection of the newly placed implant(s).
The basis behind late implantation after tooth extraction is to allow full bone healing so that optimum bone volume and density is achieved. We will be able to advise you on what is the most optimal timing for implant placement depending on your particular circumstance.
Ever since dental implants were first successfully placed, the original Branemark protocol stated that the initial phase of implant integration be at least 4 to 6 months before any restoration was placed . This is known as "conventional loading" which is a reliable, predictable, and well accepted treatment modality. However this treatment does prolong the period in which patients are without teeth after the implant is placed.
The concept of implant immediate loading is designed to promote shortened treatment periods so as to give patients teeth in the shortest time. This has important applications for example in cases where there are missing front teeth and patients want replacement teeth as quick as they can for aesthetic reasons. Or in cases where full mouth implants are placed, the patient does not want to use a removable denture, which can have decrease function, speech, stability and comfort.
The primary goal for immediate loading is to provide temporary teeth during the implant healing phase followed by construction of permanent teeth that could be either crowns, bridges or implant supported dentures. Immediate loading can be classified into several groups. These are:
- Immediate loading: The placement of implants and insertion of teeth are completed in the same day.
- Early loading: The teeth is connected to the implants at a second procedure between two weeks and three months after implant placement.
- Delayed loading: The teeth is connected at a second procedure after a conventional healing period of 3 to 6 months.
There are many factors that determine whether the patient is a suitable candidate for implant immediate loading. One of the most important factor is the establishment of initial direct bone to implant contact to facilitate primary stability and that any teeth that are placed immediately onto the implants following surgery are out of occlusion. This is to ensure that any biting pressure does not place undue strain on the implant during the healing phase that can cause the implant to move leading to loosening and subsequent failure of the implant. Other factors that affect immediate loading can be divided up into several categories:
- Surgery related factors - primary stability, bone health and stability
- Host related factors - tobacco use, oral hygiene, medications, systemic diseases such as HIV/AIDS, diabetes mellitus, osteoporosis etc.
- Implant related factors - implant size, design, and surface
- Bite related factors - bruxism and clenching, natural teeth support
Every case has to be assessed on each individuals merits both individually, surgically and prosthetically to ensure that the push to having immediate teeth does not unduly jeopardise the longevity of the implants.
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