Periodontitis: Immediate implant or wait?

This patient has periodontitis.  I would like to know if it would be a sound treatment plan for me to extract the anterior teeth and immediately place implants? Or should I wait and plan for implant placement later on?

10 thoughts on: Periodontitis: Immediate implant or wait?

  1. Priya Sharma says:

    If it is a chronic periapical lesion on 11, without any acute symptoms and without pus after extraction, then immediate implantation can be done aftr careful socket debridement. Ofcourse periodontitis should be brought to a stable stage with deep scaling n root planing, regular prophylaxis prior to implantation.

  2. Marcus says:

    How is this not a full upper extraction case? OMG that would be grounds for a College disciplinary hearing leaving that posterior nightmare and placing elective implants!

  3. Eunice Janzen says:

    My best prof in university 35 years ago was a periodontist. The FIRST thing I was taught was to assess perio and treat disease before any restorative decisions were made. This principle has served me in very good stead over the years.
    This patient clearly fails the perio exam, with, in my opinion, generalized rampant disease. The patient did not get to this place because of his/her commitment to dental health. My recommendation to the pt would be an immediate CUD and reassess function in 1 year, with the POSSIBLE discussion of an implant retained prosthesis. Regarding the lower arch….loss of all teeth at one time is a difficult concept for many patients. Hence, I would begin with a complete hygiene workup on the lower arch, clearly advising and reminding the patient that these teeth will probably not be “lifers”. That being said, functioning against a CUD, and placing a LRPD may work reasonably well for 5 years. This will give the pt the time to get used to prostheses in their mouth, and give you time to evaluate their commitment to oral hygiene in the lower arch and educate them on the concept of a implant retained CLD. In my opinion, it is unreasonable to consider implant placement at all in a mouth full of disease. Once you set this “rule” in your office, you will establish yourself apart from many others who think only about replacing teeth, irrespective of mouth and body health.

  4. FGS says:

    Never build a castle in a sea of sepsis. Perhaps a comprehensive exam, diagnosis, and treatment plan are the first orders of business. Anything less and you and the patient are doomed to failure. Periodontitis and peri-implantitis are close kin. Disease control first, which in this case includes many extractions and controlling the periodontitis in the teeth deemed salvageable, and then reconstruction. Unfortunately, many patients think that implants are the magic wand of dentistry. This patient must be given a realistic appraisal. You would be doing yourself a favor to not treat this patient, if after a detailed discussion, the patient will not accept your approach. Good luck.

    • Ed Dergosits D.D.S. says:

      Even if this patient had unlimited funds I would extract all remaining upper teeth and place an immediate complete denture. The lower teeth will survive well with scaling and root planing when they oppose a complete denture if the patient makes significant changes in habits and demonstrates great oral hygiene on the remaining lower teeth. Next step would be to fabricate a final upper complete denture and a lower cast framework partial denture. Be sure to use stress breaking clasps like an RPI design. I have seen many patients maintain and be happy very similar treatments for more than 15 years.

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