Immediate implant after traumatic avulsion: thoughts on placement?

I recently placed an immediate  4x13mm implant in the right maxillary incisor region following a traumatic avulsion.  The primary stability was 30Ncm.  I did not raise a flap because the area was lacerated.  I noted that the facial bone was intact.  The gap distance for  the implant was small, so no bone graft was placed.  A resorbable collagen membrane  was placed and closed for submerged healing.  From the periapical x-ray, the implant seems too deep.  But, actually it is only 1mm subcrestal at the midfacial.  Is this too deep?  What would be an ideal depth in a case like this?  Should I anticipate any prosthetic problems when restoring it?  Your feedback would be appreciated.

4 thoughts on: Immediate implant after traumatic avulsion: thoughts on placement?

  1. Dale Gerke - BDS, BScDent(Hons), PhD, MDS, FRACDS, MRACDS (Pros) says:

    It is hard to say from your radiograph if it is too deep or not. It certainly looks deeper than I would recommend but you say it is only 1 mm. However if the implant is 13 mm long, then it seems to me that the implant is about 3.5-4mm below the bony crest??
    If this is the case then it is similar to a case presented about 4 weeks ago on this website. The problem will be maintaining the implant and crown and also loss of bone interproximal to the adjacent teeth.
    If you have just placed the implant I would suggest you withdraw it 3 mm and use some grafting material around the implant. It seems you are doing a 2 stage technic so you should be able to do the above reasonably easily. If necessary, you might be able to use a slightly wider implant but it is hard to know without a clinical examination of the space available.

  2. Dr J says:

    Always use narrow implants such as 3.3 in esthetic area such as central and lateral incisor in fresh sockets and graft the gap. We do know that no matter the size nor diameter of the implant we do have buccal bone resorption that will lead someday to facial recession. 1mm subcrestal isn’t too deep but honestly I can’t believe that is only 1mm, by the x ray it looks like something between 4 and 5mm. You should always antecipate your prosthetic outcome and place your implant based on it. The gingival margin of your future crown should be around 3-4mm of the platform of the implant. Also, I would never put an immediate implant in cases where’s soft tissue defect, and you say the area was lacerated. Really unpredictable. Play safe.

  3. FES says:

    You are probably committed at this point in using a 4mm diameter implant, to maintain the 30Ncm insertional torque. However, you should remove the impalnt now, replace with a 4 x 15mm or 4 x 16mm. Don’t go any further apically than you are right now, which looks to be perfect. Bone graft the coronal gap as mentioned above , place resorbable membrane and let things sit for 6 months.

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