Implant placement after extraction

Date: 29/06/2018 / Author: Mr Tân

Implant placement - What is the best way for the implant placement after extraction? According to the consensus conference 2008 held in Germany, time for implant placement after extraction is divided into four categories: place the implants at the same time with tooth extraction; early implant placement, usually 4 weeks to 8 weeks after tooth extraction; implant placement after partial healing, usually 12 weeks to 16 weeks; delayed implant placement 6 months after the tooth extraction .

 Recommended implant placement cases

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The results and methods may vary depending on the individual's condition

Type 1: Implant the dental implants at the same time with extraction.

 Type 2: Place prematurely the dental implants, usually 4 to 8 weeks after tooth extraction.

 Type 3: Implant prematurely after the partial healing, usually 12 to 16 weeks.

Type 4: Delayed implant placement,  6 months after tooth extraction.

  Each type has its own advantages and disadvantages.

  Because the implant is placed right after the tooth extraction, it is not necessary to open the gums again (the flap). So It is hard for the operated doctor to define the shortage or sufficiency of the wall bone

  The hard palatine bone pushes the implant out.

  Patients with thin gum tissue.

 Loss of soft tissue due to sinking healing.

  Doctors lack of skills and expertise.

  Shorten the treatment time but the cases meet the ideal clinical conditions to achieve aesthetic when applying type I:

  The outer bone is intact and thick.

  Thick gum tissue.

  There is no infection at the implant site.

  Low laughing line: when the patient laughs do not see much-exposed gums.

  Patients with no risk factors such as smoking, alcohol, ...

According to Dr. Vo Van Nhan: Since implant position is the aesthetic dental area (front teeth), after the implantation, the temporary teeth are attached so that patients do not suffer the teeth empty. However, temporary teeth will not touch the joint with the lower teeth.

After 3 months, temporary teeth are replaced with porcelain teeth on the implant, finishing the treatment.

 What is implantation soon after tooth extraction from 4 to 8 weeks:

 Increased the horn tissue from 3mm to 5mm, which helps to seal the wound easily, thus eliminating the risk of acute or chronic infection.

 According to Buser D 2008, 2009, there is less slip gum in type 2 comparing to type 1

Because of these advantages, type 2 is widely prescribed for cosmetic areas such as the incisors.

However, during the healing period from 4 to 8 weeks, the bones are slightly lost on the outside, the width of the alveolar bone and the crest of the alveolar bones are unchanged.

Dr. Vo Van Nhan and his team operate the dental implants

The results and methods may vary depending on the individual's physical condition

Type 2 clinical case:

The female patient suffered from an accident broke the front teeth and soft tissue lesions on upper lip and chin. After examining the wound condition, we decided to proceed with implant treatment 8 weeks after the patient was injured.

After that, the dental implant surgery was performed quickly and the patient has had the temporary teeth after surgery for a few days. However, this is a temporary tooth so it does not touch the lower teeth join. This temporary tooth will be replaced by fixed restoration after 4 months.

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Note: The effect of treatment depends on the person's physiology

The results and methods may vary depending on the individual's condition

Four months later, the gums were fully healed and the implants had the needed time to achieve the desired bone integration results. This is the appropriate time for the final restoration of the implant.

The future implants that need only a few bone grafts or in some cases do not require bone grafting so the healing time is shortened and the cost of treatment is reduced. Therefore, type 3 dental implant is assigned to the aesthetic area such as the front teeth. However, this technique also applies to the position after the extraction of the lower jaw if the bone width is more than 8mm. 
Although the bone has partially healed, the wall bone is intact, large alveolar tooth achieving the initial stability of the implant, which is also a challenge for the treating doctor.

 Type 3 clinical case:

Doctor: Dr. Vo Van Nhan

The 40-year-old female patient lost her lower jar teeth due to infection. After extracting and infection treating, we decided to implant the dental implants 4 months after the extraction.

Throughout the Panorex film, we immediately identified the infection teeth, the appearance of diminishing the jaw bone causing loose teeth, so the first solution is to extract the teeth, scrape infection clean to prevent more serious bone loss making it difficult to restore the teeth later.

Four months after the extraction, the gums and alveolar bone had healed partially. This is one of the factors that help increase the initial stability of the implant. In this case, although the bone had healed partially, the alveolar tooth width is still large, so during the implant transplant, we performed an artificial bone graft.

Immediately after the dental implantation, we took x-rays to check the position and direction of the implants to ensure high success rates.

Note: The effect of treatment depends on the person's physiology

The results and methods may vary depending on the individual's condition

Four months after the dental implant surgery, bones were developing and integrating well with the implants. This is the suitable time to do implant restoration. This stage is a mild surgery to reveal the implant, preparing for the final restoration.

At this stage, we were going to implement an important technique to regenerate the gums to achieve the highest results, which is the technique of creating aesthetic gums. However, this technique is very simple, mainly based on the technique of the doctor.

Immediately after the fixation on the implant, we conducted a Panorex film to determine the tightness of the porcelain teeth and the dental implant because this job cannot be determined with the naked eye. The tightness helps to restore the chewing function and prevent implant inflammation caused by insufficiency.

Implant for patients, especially who aged 18 to 20 years old. This situation is also applicable to patients who can not implant the dental implants soon after the extraction because of personal reasons.

However, the major disadvantage of waiting for healing after 6 months or longer is to decrease the width of the crest bone less than 6 mm. This risk is higher in maxillary teeth as well as in small molars. Therefore, implant the dental implants after teeth extraction for 6 months or more may require the bone graft. In addition, waiting too long to make this treatment process is not a priority choice for patients.

 Type 4 clinical case:

Doctor: Dr. Vo Van Nhan

The female patient wearing removable dentures over 5 years due to loss of front teeth in an accident. Over the past 5 years, the patient was confusing so many times when the dentures are out while working with customers as well as colleagues so she came to us with the desire to have permanent dentures to be more confident in communication and improve chewing function.

After performing the three-dimensional CT scan and imaging examinations as well as conducting pre-operative oral hygiene and some tests to assess the general health of the patients, we simultaneously performed the dental implant surgery and bone graft.

The dental implant and bone grafting process took about half an hour with the help of a cardiologist who monitors the patient's blood pressure even this was not a complicated case. During the implant placement, checking x-ray examination the direction and position were always paid attention because we did not allow any negligences. To complete the surgery, we used a diaphragm to fix the graft and finally sewn the wound. 
During the waiting time of the final implant restoration, the patient could re-use the old disassembled dentures or used new temporary teeth provided by our lab.

Note: The effect of treatment depends on the person's physiology

The results and methods may vary depending on the individual's condition

After the needed time for the dental implants interacted with the bone (in this case 3 months), the implant is exposed for the final restoration. This stage went smoothly and quickly. During the implant disclosure, we performed a technique to help create the natural gums like before not missing teeth.

The modern aesthetic porcelain teeth are not blackened over time, high biometric compatibility so it is very suitable for aesthetic areas such as the front teeth.

Before attaching the porcelain crown to the implant, the rib test is carefully performed with the support of the x-ray film because at that time we are able to confirm the ribs is close.

The implants are implanted at the same time as tooth extraction help to shorten the treatment time and achieve the high aestheticism if properly indicated. However, the disadvantage of type 1 treatment is that it causes the outside gum recession.

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