international magazine of oral implantology

Fig. 7_X-ray prior to extraction of 22. Fig. 8_X-ray immediately after im- plant insertion, correct position of the titanium implant (Thommen Element 4,2). Fig. 9_Implant loss by manufacturer. Fig. 10_Pocket depth 4–6 month after tooth extraction i.e. implant insertion. Fig. 11a_Periimplant soft tissue im- mediately before insertion of the crown (male, 58-year-old) (Straumann RN 4,1). Fig. 11b_Periimplant soft tissue with crown. I research _ immediate implant insertion 16 I implants1_2011 too “large bone jumping distance”, in general not more than 1,5 mm.1 During the implant insertion process it is easily possibletogainacertainamountofbonedust,which can be squeezed into the gap between implant and alveolus (Figs. 1 & 2). Since consecutive bone remodeling processes af- ter extraction lead to a reduction of the buccal crest, itisofadvantagetoplacetheimplantwheneverpos- sible in a palatal respectively lingual position. An atraumatic surgical procedure is of high importance. To avoid additional bone loss a flapless operation is recommended. However, despite atraumatic extrac- tion technique the resorption of buccal bone follows it own rules.2, 3, 4, 5, 6 Conventionaltechniqueswithtitaniumscrewim- plants show a succesful longterm outcome between 94–96% independent from the manufacturer.7 The aim of this investigation was to assess, whether immediate implant placement after extrac- tion leads to a success rate comparable to delayed (2 months) or late (4–6 months) insertion. _Materials and methods Between February 2001 and January 2010 120 screw shaped implants were inserted into single root extractionsocketsin109patients,78,3%ofthemfol- lowingflaplessprocedures(Figs.3&4).115oftheim- plants could be examined during the follow–up pe- riod (drop out = 4,1%). 104 two-piece titanium (75 Straumann and 29 Thommen) and 11 one-piece zirconium dioxide im- plants (Z – Systems) were used. Small periapical granulomas were not excluded from immediate implant insertion, but meticulously drilled out. The patient sample included 9 smokers (less than 10 cigarettes per day), 4 Patients with hep- atitis B, 3 patients with diabetes mellitus (oral antidi- abetics) and 1 Patient with inapparent HIV-infection. Theimplantswereplacedutmostinapalatalorlin- gual position respectively. Bone remodeling after ex- traction had to be taken into account.8 The incongruence between extraction socket and implant surface was spanned by using autogenous bone dust/cancellous bone from the bore-hole (Fig. 5). In none of the cases immediate loading of the im- plants was performed. Provisionals were fixed at the neighboring teeth (Fig. 6) whenever possible. Re- movable dentures were adapted to the situation re- quired. In the case of zirconium dioxide implants resin splints were used to touchless shield the one- piece implant. Regular clinical examination of stability and peri–implant soft tissue status was performed 1, 2, 3, 4 and 16 weeks after implant insertion, final as- sessment 6 month after definitive prosthetic load- ing. Radiological examination was done before tooth extraction, immediately after implant inser- tion (Figs. 7 & 8), after osseo-integration of the im- plantsandnotearlierthan6monthsafterprosthetic treatment. _Results 7 of 115 implants (6,1%) were lost during the os- seous healing period, whereas later no implant loss occurred until now. The survival rate of Straumann titanium implants (n=75) was 96,0%, of Thommen titanium implants (n=29) 96,6% and of Z-Systems zirconium dioxide implants (n=11) 72,7% (Fig. 9). No differences between the 3 implant types were found in the soft tissue. The mean pocket depth (PD) was 2,3 mm (Fig. 10). No peri-implantitis with Fig. 8Fig. 7 Fig. 11bFig. 11a Fig. 10