Immediate Dental Implant Placement
When a tooth cannot be saved due to a fracture, failed root canal, or root resorption (shrinkage) it is often possible to replace the tooth with a dental implant, placed immediately after the tooth is removed. There are three critical aspects to the procedure that should be considered in order to make this treatment option successful.
- Removal of the existing tooth or root without damaging any of the surrounding bone or gum tissue.
- Simultaneous placement of the implant that engages sufficient bone to create stability until the bone has time to grown around it
- Placement of a provisional (temporary) crown that avoids minor biting forces and micro-movement of the implant
The first step in the process is a special surgical technique to remove the tooth while preserving the bone and gum tissue to achieve the ideal esthetic result. Any damage to the bone could cause an unsatisfactory result, which is unacceptable in the front of the mouth. Therefore, this procedure is usually performed by surgical specialists with extensive experience removing teeth in preparation for dental implants.
Immediately after the tooth is removed, a dental implant is placed using a delicate surgical technique to avoid damaging the bone. The dental implant must be placed so that it is stable and this usually requires affixing it to the bone at the very tip of the tooth socket. Bone grafting material is often placed around the implant, filling in the socket completely to maintain natural contours. The position of the dental implant is critical to ensure that the crown emerges from the gum tissue exactly like a natural tooth. Due to the precision required for this procedure, the surgical specialist must be experienced to ensure a successful outcome.
Options for a provisional (temporary) replacement tooth include a crown placed immediately after the surgical procedure, a removable flipper with a tooth attached, or taking impressions after surgery and placing a provisional crown a few days later. The provisional replacement tooth is primarily for esthetic purposes, rather than function. It is placed so that it does not touch the teeth opposite it to keep the forces of biting off of the dental implant, allowing the bone to remodel around the implant without movement or pressure. Even gentle biting force, causing minor movement, can prevent the bone from fusing to the dental implant. Once the bone has formed a strong bond with the dental implant, providing a stable foundation, the final crown can be attached to the implant.
Delayed Dental Implant Placement
When there is insufficient bone to stabilize the dental implant immediately following tooth removal, the surgical specialist might determine that it would be better to delay placement of the implant. A bone graft placed following tooth removal, as seen in the illustrations below, fills in the socket where the tooth root is missing, preserving the natural contours of the bone and gum tissues.
The bone graft also allows the surgical specialist to place the dental implant in bone that provides stronger initial stabilization of the dental implant. After the dental implant is placed a provisional (temporary) replacement tooth is placed for esthetic purposes only. This can be a removable flipper with a tooth attached, or a temporary crown, which is placed so that it does not touch the teeth in the opposite jaw, since biting forces can cause movement of the dental implant and result in the lack of complete integration with the bone. The dental implant is left undisturbed for several weeks so that the bone can remodel around, or fuse to the dental implant. Following the appropriate period of time, as determined by the surgical specialist, a small connector post called an abutment is attached to the dental implant. The final crown will be attached to this abutment.
Following the appropriate period of time for the bone to remodel, or fuse to the dental implant, a small connector post called an abutment is attached to the implant. The permanent replacement tooth will eventually be attached to the abutment.