Dental Implant in Fresh Socket
Posted in Surgical Placement of Dental Implants Treatment Planning & Complications
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Subscribe to this PostDr. Taylor asks:
When placing a dental implant into a fresh socket, and there isn’t complete fill of the residual socket by the dental implant, would you fill the space with a bone graft and a membrane, or just use a membrane?
Also, how would your dental implant treatment plan differ if you wanted to provide immediate temporization in this situation?
Dr. Taylor, last week I was with Jan Lindhe in Buenos Aires (Argentina), and he told us that if you place implants in a socket (postextraction technique) you have to place most lingual you can, cause if you fill all your buccal space in socket, there´s no marrow bone formation so, you loose that buccal bone, membrane – non membrane, graft – non graft is a secondary item.
Hotest Regards.
In most cases of immediate implantation into extraction sockets I do fill the gap with an allograft.Membrane is to be used whenever buccal or lingual plates are missing.
Temporization is the same as long as primary initial stability is maintained.
Dr Taylor:
We usually close the gap with puross mixed with prp and do inmediate temporization if the implants are 10 mm or more. We normally dont use membrane because we do flapless surgery and in that case the periostium works wonderfully, even if you need to graft. Read some articles or contact Paul Petrungaro.
best of luck
Dr Taylor,
We use Bio-Oss and a Bio-Gide membrane (if necessary) along with PRP to close the gap. Dr Tony Sclar has a wonderful program the first Qtr of each year in Miami. Check out the ISTM website @ http://www.drsclar.com.
Every gap under 1.5mm will be filled by nature in 75% of the cases so I allways fill the Gap wiyh Bio-Oss. If the buccal wall has gone I first regenerate with a membrane and Bio-Oss and then I place the implant flapless after 9 months.
Best to build the bone first, then place the implant into living bone. Why risk the area not filling in with bone?
Placing the implant immediately will help in prevention vertical loss of bone.If the gap is less than 1.5 mm nature will sort it out
(botticelli) or pack with Beta tri Ca Phospate (cerasorb) if more.Placing the implant gives the bone a reason to remain..
What happens when you have, let say a gap of 2+ mm, you just let it fill up with blood and cover the whole with a membrane (Bio-Gide)?
Whill you not just have the same effect as filling the gap whit Bio-Oss or any allograft?
listen to dr.callan.
RISK vs BENEFITS.
STAGED APPROACH; LESS RISK BETTER SUCCESS.
Sounds gross. Let’s think about the patient. Healing then implant. Monetary rewards come later.
If the preservation of the perimeter bony walls of the socket at extraction is adequate, then a new alternative may be available in the US soon -at least for the molar region. At this year’s AO, it was mentioned that the MAX implant by Southern Dental implants is wide enough to engage the walls; the tapered geometry of this implant allows for excellent primary stability as it has a natural fit to the socket shape in the molar region only. The MAX implant should be available by the end of this year.
I have placed implants immediately when everything was perfect and the osteotomy allowed for immediate stability, thick buccal wall, thick KT, good med hx, osteotomy by the book, compliant patient…all is right with the world. Ive also been there where conditions were in the “I-think-I-can-make-this-work-ok” for immediate placement and have gone forward. Once you see a buccal wall totally (and I mean TOTALLY) disappear even when you think you have done everything right but everything wasn’t perfect, it will make you think twice. Again, listen to Dr Callan. You can do certain things to promote integration quicker, but you will never rush biology. it will happen when it will happen and every patient is different. And when things go south with implants, it can be like antarctic south and its not a fun day at the office for anybody. Maria, whats so special about the MAX implant taper, arent they all? Taper or not, biology is biology. The current literature reveals success on either side of this debate and the verdict isnt in yet.
Im relying on basic sound principles of biology and not in a hurry. The literature also reveals that there is a bone gain by grafting first that may increase the amount of bone around delayed placement as opposed to immediate placement, and there are many variables in success. Im still learning. Bill
I am not going to comment on Dr. Taylor’s original question, but I would like to add to Maria’s commemt and Dr. Woods questions/comment.
Dental implants perform better when there is less micro-movement, hence good primary stability. And if this can be achieved at the time of extraction than many things will be accomplished i.e. less surgical procedure for pt, preservation of bone
cont.
and possibly immediate placement of a provisional. All these things make for a happier pt.
The MAX implant is designed to provide this option of treatment for you and your pt’s. The implant sizes are 8 & 9mm width x 7, 9, & 11mm lengths and are meant to be immediately placed into molar extraction sites for the reasons listed above.
I use Bio-Oss and PRF-Plateled Rich Fibrin.
/it isnt the same thenPRP/
PRF membrane for the barier.
It,s a imprtant to place the implant more palatal or lingual,to prevent bucaal bone.
Kris
Boticelli et al showed us some measurements between implants and wall sockets….less then 1,5 mm is a reasonable situation to fill the gap with BioOss, but……why we use BioOss as a magic material in extreme cases, where is no indication to do it????
It is not the material, it is the doctor!!!!