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Though studies show that the remaining tooth segments showed healthy periodontal ligament at buccal side and no osteoclastic remodeling of the coronal part of the buccal plate, more long term research is still needed in this relatively new technique
Mainly in upper anterior teeth with thin buccal plate
First described in 2010 by Hürzeler et al,
A partial buccal root fragment is retained to support the buccal plate and soft tissue in immediate implants
Following extraction, 35 to 40 % expected resportion in the width of the socket.
The tooth root section’s periodontal attachment apparatus (periodontal ligament (PDL), attachment fibers, vascularization, root cementum, bundle bone, alveolar bone)
is intended to remain vital and undamaged so as to prevent the expected post-extraction socket remodeling and to support the buccal / facial tissues
Clinical tip: The membrane can be pierced with the healing collar which will act as a fixation method to the membrane
if gap is 2 mm or greater>> graft
The gap created between the implant and the socket walls has been debated in the literature if it should be filled with a grafting material or left to be filled with blood clot.
Clinicial Tip: Drilling through the tooth aids in the aligment and positioning of the implant
Implants ideally placed in the interradicular bone and ideally to be surrounded completely by bone
Drilling beyond the apex to get primary stability
The implant should be placed in a palatal position and with an inclination that is still palatal to the incisal edge of planned restoration.
Anterior Maxilla Implant positioning:
NB A flap is elevated if there is GBR to be done with immediate implant otherwise not raising a flap benefits from the natural soft tissue architecture present
Seperation of multi rooted teeth
Physics Forceps
Dedicated Leverage Systems: eg Benex
Periotomes
It is important to extract the tooth with minimal disruption to the alveolar bone
STEP 1) Atraumatic Extraction
Implants placed immediately after extraction
Implants placed 4 - 8 weeks after extraction
Soft tissue coverage and primary healing of socket
Implants after complete bony fill of socekts (4-6 months)
Implants are loaded with prosthetic part immedialely after implant placement; whether implants placed immediate or delayed.
Immediate Implant Placement:
Indications and Techniques