Immediate Implants Are Better Than Delayed Ones

[@mikeyoung7385]

Placing an immediate implant and a nonfunctioning provisional is the most gratifying procedure I've done in my career as a general dentist. I've done a couple dozen with great outcomes. However I've had one failure, a male, that in retrospect, probably wasn't listening when we went over post op instructions.

[@Stanleyinstitute]

Exactly what I was getting at!

[@TheFrankman711]

i like this idea as well. Besides, you already get the right ankle for placing the implant. I have seen some terible placed implants

[@Stanleyinstitute]

agreed!

[@kvgolfa]

Can you share a video of how you seal the socket on a molar immediate?

[@Stanleyinstitute]

Sure thing.

[@SP94395]

Hi Dr Stanley I enjoy your content, mainly as you present concepts that some of my colleagues would consider very polemical. I wanted to ask your opinion on the following: A Type 2, that is a delayed early placement (six to eight weeks following extraction) was taught to myself as the gold standard in the aesthetic zone owing to allowing for optimal soft tissue closure. What is your view on this? With regards to soft tissue or hard tissue augmentation, is this something you would do prior to implant surgery, or during, or never? And how would this work with an immediate implant placement and loading? If there was infection there at the time of extraction, are you confident to implant and bone graft at the same time, instead of allowing for six to eight weeks of healing prior to implant placement with concurrent hard and soft tissue augmentation to account for the lost tissue in that time? Would your method described in this video also apply to multiple implant placements e.g. for a bridge, and not just single tooth cases? Thanks in advance and apologies for the numerous questions, keep the videos coming

[@mimetrickster]

For the study that compares delayed early placement compared to soft tissue graft, the assumption for why is you get thicker tissue because it grows in to fill the area. You should be able to get the same benefit by doing a small CTG at the time of implant placement in an immediate group, which should take you about 20-30 mins once you are faster at it and saves the patient 3 months (due to avoiding an uncovery). That's my opinion on that claim of type 2 being better.

[@SP94395]

@mimetrickster Fair enough, but can you not negate that by doing a soft tissue augmentation at second stage instead, like a modified roll flap, having also buried the implant for four to six months to allow for osseointegration? So with a two stage type 2 placement, you get more than one opportunity to augment the periodontal architecture around the implant?

[@mimetrickster]

@@SP94395 that is true, the assumption made I guess is that you need more than one opportunity to augment the tissue. On straight forward cases where there zenith of the tooth was in a proper place prior to extraction or where the buccal plate is perfectly in tact, I don’t know if you need multiple opportunities to augment, it should work the first time. Let me know if my response answers your question because I’m not sure if I fully understood yours

[@SP94395]

@mimetrickster You absolutely have understood my question and I think have summed up my thoughts perfectly. I believed that in a case where there is little to no hard or soft tissue discrepancy, then an immediate implant is likely to be successful. In the majority of cases I have treated however, buccal plate damage or soft tissue loss is common, as the teeth have sustained trauma, or are in a cleft site or in non-native bone (e.g. fibula reconstructions)- I do not treat many 'routine' cases. As a result, either a Type 2 placement or a Type 4 placement may be more predictable depending on the case, which can give us multiple attempts to bolster hard and soft tissue. I would argue therefore that case selection is paramount for immediate implant provision. In a case where periodontal loss is minimal, then such a technique would work well. In certain other cases where you may wish for the opportunity to improve the playing field beforehand, then in my opinion delaying the placement by six to eight weeks in the aesthetic zone for soft tissue reasons, or longer for non-aesthetic cases may be prudent. What are your thoughts please

[@mimetrickster]

@@SP94395 I am recently out of residency and I am just starting to get cases so I don't have a lot of first hand cases under my belt. We were taught as a rule of thumb that if the buccal plate is missing or deficient during extraction to stage it with a socket preservation first and then implant placement. We did not do any delayed early placement. So I can only talk in theory not based on my experience unfortunately as it is limited. What you are staying in the sites that have deficiencies I think going delayed makes a lot of sense and I don't see anything wrong with your logic.

[@dr.tinajerov]

#immediatealways 🫡