The Importance of Being Well Informed
Immediate Implant Placement Following an Extraction
Immediate post-extraction implant placement is nothing new. Doctors Wheeler, Seul and Currimbhoy have been doing this for many years. The differences today are that with newer techniques and technologies, we can do it more accurately and therefore more frequently. What has to be understood is that this technique is far more difficult than placing an implant into a healed site. It is done blind without laying a flap, so the surgeon must have a thorough three dimensional understanding of the bone and soft tissues surrounding the site.
Besides eliminating an extra surgery and shortening the healing time, immediate implant placement can help to preserve the surrounding bone and soft tissue architecture in an area, especially important in the front of the upper jaw (the esthetic zone). Just as it can help to preserve these tissues if everything is ideal at the time of the extraction, it can do nothing to improve them!
This is why it is important to review this treatment option with an experienced surgeon before proceeding. In most instances, a delayed placement with some grafting to improve the site will yield a more predictable and potentially esthetic outcome.
Teeth in an Hour
Unfortunately, the benefits of new technology can get exaggerated, especially in marketing. We have the ability to take a CT scan in our office, and plan implant placement very accurately in three dimensions on a computer model of the patient’s mouth. If there is enough bone to safely place implants, and several implants can be placed into an area allowing the new teeth to be splinted together for stability, we can develop a surgical guide to place the implants in the same positions as seen on the computer, and construct a bridge or teeth that attach to these implants at surgery.
The marketing myth is that this is teeth in an hour. Actually there are weeks spent in designing the surgical guide(s) and fabricating the teeth before the surgery takes place. If bone grafting is needed to provide an adequate bone volume to anchor the implants, this has to be done first requiring another surgery and usually four to six months of healing before the final procedure to anchor the implants and place the new teeth. As exciting as this procedure may be, it is very expensive and few patients have adequate bone and the ideal conditions to actually place the implants with immediate crowns. There is also an increased risk for implant failure, which has been shown to be as high as 20% (normal success rates for implants placed with a healing protocol of three to six months are around 99%).
“Teeth in a Day” or “Bar Attachment Denture” Implant Restorations
A similar technique heavily marketed by centers with only an oral surgeon and prosthodontist is “teeth in a day” or “Bar Attachment Denture” restorations. This technique is very promising, but relatively new with no long term success data. Conventionally we have been replacing an entire arch of teeth for decades with six implants and grafting to replace lost bone. These newer reconstructions are only for patients without teeth and significant bone loss.”Super centers” tend to offer this technique and entice patients to have all their teeth removed to “fit the mold”. Dr. Wheeler, Seul and Currimbhoy have incorporated this option into their own practices — patients don’t have to wear a removable denture while implants are healing, and potentially fewer implants can be placed at angles to eliminate the need for grafting, but are far less aggressive and offer other options so teeth are not unnecessarily removed along with residual bone to make room for the new fixed denture teeth. Our doctors, along with their experienced referral network, can offer this technique along with alternative solutions which might preserve healthy teeth. Their team can also provide careful follow-up and maintenance not offered in most “centers”.
One of the heavily touted advantages of using a surgical guide generated from a CT scan is that the doctor placing the implants can do so without parting the gum tissue (laying a flap). The marketing myth states that this is far less painful than the old technique of separating the gum tissue to view the top of the jaw while preparing the site for the implant. Happily there is virtually no difference in recovery with or without a small flap to aide in accurate implant placement. Most patients take one or two Advil following surgery, and rarely is there any need for prescription medications unless additional grafting is needed. More importantly, studies have shown that implant placement is far more accurate when a small flap is laid and prevents poorly positioned implants and the increased risk of failure. Most dentists advocating flap less surgery do not have extensive surgical training and therefore do not feel comfortable opening the soft tissue even though it may be beneficial to the overall outcome.
Several implant companies have over the last few years developed smaller, one-piece implants primarily for use as temporary implants to help to support bridgework for only a few months while the normal or full sized two piece implants are allowed to heal properly. These temporary mini-implants are then removed simply by unscrewing them, and the standard implants are then restored and placed into function. Some companies have decided to change the surface of these temporary implants so they will fuse to the bone, and attempt to market them as final or permanent implants. This one piece design again is not new and interestingly still carries the concern that these narrow implants can fracture or break off leaving the patient with a useless post in the bone which has to be surgically cored out and replaced if there is any hope of re-restoring a patient. Long term studies for more than a few years on these mini-implants have still not been done, whereas we have thirty to forty years of evidence based research on the success of standard implants. We only use these mini-implants for temporary indications.
Count on Experience!
Our doctors have decades of experience working with and helping to develop dozens of implant systems. They presently have four different systems available to take advantage of specific advantages of each to optimize implant reconstruction and offer the best technology available. They can help you and your restoring doctor decide the best implant option for you,and help plan the entire treatment sequence using CT scans and advanced software right in our office.
We look forward to the opportunity of participating in your care!