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The Journal of Implant & Advanced Clinical Dentistry
Immediate implant vs Ridge preservation: Whats your preference?
Sun, 03/15/2009 - 19:18 — hawkeye
There seems to be much debate in this subject. At the most recent AO conference there seems to be a move away from immediate placement. Even the NYU groups seems to shy away from immediate placement due to the complication potential and increase in complications they are seeing. Im wondering what are peoples preference and what is your protocol in determine whether to place an implant immediately after extraction or do ridge preservation and delay placement?
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Immediate implant vs Ridge preservation: Whats your preference?
I am starting to see higher failure rate and more complications with immediates. I now teach my residents to socket graft and come back and place the implant.
Less issues.
Graft the Socket....Stay away from immediates.
In my opinion it is better to graft and place the implant at a later date in sound bone then do an immediate.
I have a 8% higher failure rate with immediates then delayed placement.
Graft the site vs. Immediate Implants?? It depends.
It depends on the situation....why can't we sometimes do both? Place the implant and graft simultaneously?
I refer you to an article I published on this subject from Funato, A & Salama, M IJPRD Volume 27, No. 4 2007
See a below excerpt from their article;
Classification of Immediate Implant Placement
Table 2: Categorizing the Potential Implant Site . This classification is based on both the osseous and soft tissue levels of the potential site at the time of extraction.
Class 1: The buccal bone is intact with a thick flap gingival biotype.
“Incisionless” implant placement without flat reflection is viable (Figure 2).
Class 2: The buccal bone is intact with a thin, more scalloped gingival biotype.
Incisionless implant placement is viable but in combination with a connective tissue graft or a subsequent secondary connective tissue graft (staged) (Figure 1).
Class 3: The buccal bone is lost, but the implant can still be placed immediately within the remaining alveolar housing of the extraction socket, providing the necessary osseous support through regeneration utilizing a membrane with guided bone regeneration (GBR) and incorporating a simultaneous connective tissue graft (CTG). Depending on the degree of compromise to the buccal plate, the case may alternatively be handled in a staged approach utilizing a socket augmentation procedure with subsequent implant placement. In many instances, especially in thin biotypes, this method provides a more predictable and safer outcome.
Class 4: The buccal bone is severely compromised, and implant placement within the remaining palatal bone results in a significantly off axis implant position. In these cases, following extraction, implant placement should be delayed. If performed immediately, the long axis of the fixture inclines toward the buccal and will result in a significant esthetic compromise of the final restoration. In these situations, the delayed approach should be utilized with subsequent three dimensional (3-D) bone & soft tissue augmentation of the deficient ridge followed by optimal implant positioning.
Immediate implants VS Grafting the socket: Big Shift
I attended the Misch institute years ago and go back frequently for CE. There is definietly a shifting of thought. Immediates are falling out of favor in place of grafting.
The Saying is why sacrifice 30 years of success for moving the case forward 3 months.
Immediate implant vs Ridge preservation: Increase success
I recently went backed an looked and my failure rate has decreased by 5% since I stopped doing immediates and graft the socket instead.
Immediate implant vs socket preservation
Unless I have alot of native bone I stay away from immediates. I tend to favor a socket seal technique utilizing FDBA and calcium sulphate. I sometimes use a free gingival graft to seal the socket.
Immediate as oppose to socket preservation.
I will do an immediate if the situation is right. Adequate bone with a thick buccal plate, but 9 times out of ten I will socket graft the case.
Immediates: I am airing towards socket preservation.
I am doing less and less immediates these days. I am getting much better success and better esthetics by grafting and doing delayed placement.
I love the comments by Dr pruscde, I think there is alot to be said by placing more instead of less implants to overload an area.
Immediate Implant vs Ridge Preservation
I like the common sense answer best. Get your data together with a good scan, check bone densities, root sizes and profile, patient type occlusal patterns of opposite arch, etc. I have done immediate placement and loading for most of my major cases for years with not a single implant failure. I am not better than those that experience a 25% increased failure...I am probably more cautious...or more lucky. I start with the premise I hate failures and move forward with that attitude guiding me.
I think functional balance and patient cooperation in limiting their diet profile are two key components as to whether a case or implant succeeds or fails. I also overload the number of required implants (8 vs 6) to add security. It seems to work.
Immediate or delayed with ridge augmentation
I do think the same thing, but I do sometimes place immediates. If all walls are intact and you can acheive primary stability, then I do attempt the implant right after extraction. You do have to prepare the osteotomy to the palatal/lingual to the pressure is not on the buccal. This can be tricky. I usually do cover over with tissue and perform 2nd stage 4-6 mo later.
No cookbook approach to immediates...
Alot of this comes from "feel" and experience. Bone quality, tissue biotype, implant size/diameter, patient medical status, esthetic demands, and others all go into the decision of immediate vs. delayed. As stated below, the more you try to do at once, the more likely you will fail.
I heard Craig Misch say he charges 25% more for immediate loading b/c he feels there is a 25% greater chance he will have a failure and have to redo the case for free. Makes sense to me.
Immediates = greater risk of failure
I agree the immediates lead to a greater risk of failure. Not sure I would be comfortable charging more for immediates. Ultimately you are responsible for what you do to the patient. The risks should be laid out during informed consent.
Why do a procedure where there is a 25% increase in failure....What does it gain you???? 3 months of moving a case forward. To me not worth the risk.
Would a cardiac surgeon do one procedure over another if he knew there was a 25% risk of failure? I know its apples to oranges, but think about it.
Ridge Preservation vs immediates
I am a general dentist that does alot of extractions but do not place implants. I do alot of ridge preservation and see a difference in my practice. The surgeons I work with love it because they place the implants in a solid foundation.
Immediate implant vs Ridge preservation
Seems like this topic has come full circle. Implants early on where 2 stages, then we moved to 1 stage, then immediates, then immediate load.
My feeling is that when you push to hard you will get increase in failures.
I believe immediates have their place but if you go to enough conferences most of the experts are moving away from immediates and grafting first.
Immediate implants versus socket preservation
I still do immediates but it has to be the right situation. For the most part especially in the anterior I do socket preservation and do the implant 3 months later.
Less risk in my mind.
Immediate Implant vs Ridge Preservation
There seems to be a shift in the thought process. When people started doing implants everyone tended to 2 stage everything.....Then people started pushing the envelope doing immediates placement, immediate load, flapless etc....As of late prominent speakers at the podium at many conferences are now shying away from immediate anything.
Speakers have been showing more failures when you do immediates. Failures on many levels including esthetic nightmares.
In my practice I tend to do site preservation and come back and place the implant in a solid foundation. Why sacrifice years of implant success for 3-4 months of speeding the case along.
Immediate placement versus Ridge preservation
I tend to favor ridge preservation. I been doing less and less immediates. I find its better to graft the site and come back and place the implant in a sound foundation. Especially in the esthetic zone. I have read several articles which show recession, metal show through, etc on immediates place.
Immediate Implant vs Ridge Preservation
I first evaluate the extraction site. If there is alot of infection present, I will give it tincture of time. If the extraction site is not to infected and there is ay least four walls, I detox then perform the osteotomy, then graft with or w/o a membrane abd place the root form implant. I cover the site with a resorbable membrane and perio pack.