Preserving Smiles: The Art of Anterior Immediate Implant Placement

Anterior Immediate Implant Placement refers to the technique of inserting a dental implant immediately after extracting a failing or non-restorable tooth, all within the anterior region of the mouth (the front teeth).

This approach holds significant importance as it enables dentists to promptly restore aesthetics, and preserve the surrounding bone and soft tissue. By eliminating the need for a separate healing period, patients experience reduced treatment time and enhanced convenience.

The purpose of temporary restoration in this process is twofold: first, to preserve the soft tissue profile and reduce teeth movements during the healing phase, and second, to provide patients with immediate aesthetic benefit while waiting for the osseointegration of the implant.

When to Consider Anterior Immediate Implant Placement

When considering Anterior Immediate Implant Placement, a thorough assessment of the patient’s case is crucial to determine its suitability. Indications for this approach include the extraction of a non-restorable or failing tooth due to trauma, infection, or periodontal disease. Patients also need to have adequate bone volume and good overall oral health.

However, several contraindications and factors must be carefully considered. Patients with systemic health issues, compromised immune systems, or inadequate bone density might not be suitable for immediate implant placement. And the most important being the bone volume at the site of the intended implant.

The ideal timing for the procedure involves strategic planning for tooth extraction. Preservation of the alveolar bone is critical, as immediate implant placement helps maintain the existing bone architecture and prevents resorption. Experienced dentists utilise atraumatic techniques during extractions to minimise damage to the surrounding tissues.

Bone preservation and grafting considerations are other aspects of the process. In cases where there is insufficient bone volume, minor bone grafting techniques may be carried out to enhance implant stability and to help with gingival support to maintain ideal soft tissue contours for best esthetics. The success of anterior immediate implant placement heavily relies on the dentist’s ability in assessing the patient’s situation and customising the treatment plan accordingly, ensuring optimal results.

How to Perform Anterior Immediate Implant Placement

Pre-operative Planning and Imaging Using CBCT Scans:

Before proceeding with anterior immediate implant placement, the dentist conducts a thorough pre-operative assessment. This includes obtaining a Cone Beam Computed Tomography (CBCT) scan, providing detailed 3D images of the affected area. CBCT scans aid in evaluating bone quality, quantity, and the proximity of vital structures, ensuring precise treatment planning.

Treatment Planning Software Utilisation:

Advanced treatment planning software is utilised to analyse the CBCT images, allowing the dentist to virtually place implants and select the ideal size and angulation. The software aids in simulating the implant placement process, ensuring accurate positioning for optimal aesthetics.

Surgical Procedure
Anesthesia and Incision:

On the day of the procedure, local anaesthesia is administered to numb the surgical site effectively. The dentist carefully plans the incision location to maintain the patient’s natural gingival architecture while providing adequate access to the extraction site.

Tooth Extraction and Socket Preparation:

The non-restorable or failing tooth is atraumatically as possible extracted, taking care to preserve the surrounding bone and soft tissue. Minimising trauma during the extraction process is crucial to maintaining the integrity of the extraction socket. This is crucial especially in an anterior immediate case scenario. Thus minimising additional surgical stages later.

Implant Selection and Placement:

Based on the pre-operative planning, an appropriate dental implant is selected. The implant is then carefully placed into the prepared extraction socket using precision drilling techniques and appropriate sequence. The goal is to achieve primary stability, ensuring the implant remains firmly fixed within the bone. The primary aim at this stage is achieving the best primary stability value in terms of Newton Centimetres(Ncm). Best primary stability values start at a minimum of 35Ncm, less than this value the case may not be best suited for immediate restoration.

Customised Temporary Abutment:

After successful implant placement, a customised temporary abutment is attached to the implant. The temporary abutment mimics the natural tooth shape and contour only at the gingival level, allowing for an optimal soft tissue and emergence profile.

Temporary Crown Placed (if possible):

Ideally, a temporary crown is then placed to blend seamlessly with the patient’s dentition. This is planned for, but if the primary stability is less than 35Ncm it is not safe to immediately restore the implant. In some cases in spite of the best planning the human biology determines the outcome and in some cases is not possible to restore immediately. This then means the patient will need to be provided with a temporary removable option.

Long-term Maintenance and Final Restoration

After the anterior immediate implant placement procedure is complete, a crucial healing period begins. During this time, osseointegration occurs, where the implant fuses with the surrounding bone, ensuring stability and longevity. Patients must follow post-operative care instructions diligently to promote successful osseointegration.

Once the healing phase is complete and the implant has integrated, the transition from temporary to final restoration takes place. The dentist removes the temporary crown (if placed) and replaces it with a custom-designed, permanent restoration. This final crown is carefully fabricated to achieve optimal aesthetics, function, and patient satisfaction.

Dentists should schedule periodic follow-up visits to monitor the implant’s health and make adjustments if necessary. By ensuring diligent maintenance and providing routine check-ups, the implant can continue to deliver functionality and natural aesthetics to the patient’s smile.

Wrapping it up

Anterior immediate implant placement offers numerous benefits to your patients, including reduced treatment time, preserved aesthetics, and improved satisfaction. The immediate loading concept allows for quicker functional restoration while promoting bone preservation and soft tissue support.

With meticulous planning, precise execution, and long-term maintenance, dentists can confidently offer this advanced procedure, achieving exceptional results for their patients.

Get access to the original article here.