Sacramento Dental Implant Assessment

If an immediate replacement of a failing tooth is considered, a diagnostic evaluation begins with a radiographic assessment of the failing tooth. Clinical symptoms such as pain, exudation, and fistulation, and radiographic findings of apical pathosis and presence of chronic infection or granuloma with bone loss can be a contraindication or risk factor for immediate implant placement. Also, the interproximal bone level should be at a normal height of 1mm to 2 mm apical to the cement-to-enamel junction of the adjacent teeth. If the above criteria are not met, bone grafting and possible soft-tissue grafting should be performed. The area should heal for four to six months. The site success or improvement depends on the amount of facial bone loss. The use of a surgical guide to compensate for the lack of vision during immediate placement is recommended. The surgical aesthetic guide should demonstrate the facial contour and the extent of the free marginal gingiva (FMG) of the implant crown. This is the reference point used by the surgeon to place the implant 3 mm to 4 mm apical to the FGM.

One of the principal advantages of the immediate technique is the prevention of post-extraction bone resorption. According to Carlsson, the bone loss may affect approximately 23% of the anterior alveolar crest during the six months following extraction. This averages out to about 4 mm in the buccal direction. The manv advantages of immediate implant with same day provisionalization include preservation and optimization of the soft-tissue contour, reduction of treatment sequences, enhanced patient comfort, and aesthetics (the patient leaves with a fixed provisional).

Use of one-stage implants has resulted in demonstrated success comparable to that of two-stage implants. When properly inserted in good-quality bone, and when sufficient implant stability was achieved, osseointegration was not compromised. Micromovement at the bone-implant interface resulting from inadequate primary stability is the cause of fibrous encapsulation. The range of tolerance for these micromove-ments is 50 to 150 pm for rough surfaces and about 100 pm for smooth machined surfaces. Rough surfaces appear to tolerate greater micromovements and therefore could be placed under load at an earlier time. The stability of an implant depends almost entirely on the mechanical interlocking between the mineralized bone and the roughness of the implant surface. Consequently minimum insertion torque resistance of 35-50 Ncm have been suggested during immediate loading of implants. Usually the blood clot is sufficient to initiate healing, and bone grafting may not be necessary. A conservative, flapless surgical technique maintains vascularization and bone volume. It can prevent soft-tissue recession and preserve interdental papillae, especially in the presence of thin, scalloped gingival architecture.

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