Immediate Placement of One-Piece Dental Implant-Abutment

Dr. Sefer asks:
I am considering an immediate placement of a one-piece dental implant-abutment at the time of extraction to replace an anterior tooth.

One complication is that the area around the tooth that I will be extracting is infected. I am also intending to place a temporary crown at the time of dental implant placement. For those of you who have done this, what kind of prognosis should I expect? What do you advise?

8 thoughts on “Immediate Placement of One-Piece Dental Implant-Abutment

  1. Perhaps you should Google the issues surrounding the one-piece nobel direct implant. Many reports indicating unacceptable bone loss.

    Why place something without much clinical support. What’s wrong with placing a reliable implant and place the abutment at time of surgery?

  2. Everyone wants it all done asap some cases are better to wait and where there is infection beware !!! avoid split roots etc

  3. “Local infection” is a fairly broad term. Critical feature would whether the labial bone is intact, the distance from the labial bone to the gingival margin (which obviously you do not know until extraction), and whether adequate primary stability can be achieved (35-45Ncm). I place Nobel Replace tapered groovy fixtures, as an immediate extraction and implant placement, and IF ALL GOES WELL, place an immediate provisional abutment (IPA) and construct a provisional crown, and retain it with temp bond. These cases are technically tricky, and the implant needs to be angulated towards the palate, rather than just placed into the socket. I would avoid one piece implants in such cases, as it removes flexibility, and maked your task even more difficult. I prefer to allow the implant to integrate, and restore with custom zirconia abutment and all ceramic crown. My best advice would be “don’t be in a hurry”, if problems are encountered, be prepared to allow the site to heal and place it as a conventional procedure.

  4. One-piece implants are a natural progression (or should I say regression as they are not new) with the increased popularity of immediate loading. If you are going to place an implant and then attach the abutment to support a temporary restoration left out of occlusion for a healing period, why not make the implant one-piece. The why not depends whether you are placing one implant in the non-esthetic zone, multiple implants that require parallelism or implants in the esthetic zone that may require angled abutments. The advantage of two-piece implants has traditionally been the ability to do an implant level transfer and fabricate the abutment indirectly on a working cast, but with the advent of snap-on transfers and abutment analogs, you can now attach the abutment and make an abutment level transfer.

    One of the problems with one-piece implants is that implant companies add the amount they charge for the abutment to the price of the implant bringing the cost of a one-piece implant to $470 and over $500.

  5. You mean Immediate replacement in infected socket with one piece implant where implant and abutment has no connection. And this is ideal when properly placed in anterior areas so no baterial colonies at the interface. care of infection ,extend to sound bone,put temporary out of occlusion essential & care of bruxism at this area. High success rate& excellent esthetic.

  6. I have utilized the Zimmer One-Piece Implants with great success. Over 60 placed without a single failure. The system allows for a verification process using the “try-in” implants to evaluate whether you need the straight or 17 degree angled implant. The unique feature here is that it has a “contoured” abutment that I have never had to prepare in the mouth! This then allows for the best part of the system….the snap on components.
    Temp Cap, Impression caps etc.
    This now becomes a SCREWLESS system for the restorative phase which is better biologically for maintaining crestal bone levels and enormously effecient for the clinician!! Easily the best Unibody system on the market today!

  7. After extracting a root, a three dimensional curretage of alveolar and irrigation is helpful. three main questions need to be answered.
    1) can we place an implant and acquire 30N torque?
    2) Do we have enough volume bone to place an implant
    3) Between the implant and inside surface of the alveolar bone is there going to be a gap and what we are going with it?
    I do have successful treatment with the immediate placement and immediate restoration but in the cases which the answer of the 1st and the 2ed questions are yes, 3rd question we have different techniques to treat the gap but with out any type of GBR with or without barrier membrane.
    I use One Piece Immediate Load Screw implant of the Nisastan system with the divergent gingival height surface. most teeth replaced were lower central incisors and upper lateral incisor.
    Dr S Namjoy Nik
    DDS, MSc, PhD (Dental Implantology) UK

  8. I think it is best to take care of the infection first. Let the area heal and then place the one piece dental implant. OCO Biomedical make a nice one piece implant in sizes from 3.0 to 5.0mm. They are TiNi coated in the collar and abutment areas to mask the grey Ti.

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