Immediate Dental Implants for Esthetic and Premolar Sites

List of Contributors ix

Foreword xvii

Preface xviii

Acknowledgments xix

1 Introduction, History and General Principles 1
Douglas Deporter, Domenico Baldi, and Mohammad Ketabi

Background 1

The Timing of Implant Placement 1

Early Work with Immediate Implant Placement 6

Biological Benefits of “Immediacy” 7

Indications for Immediate Implant Placement in Anterior and Premolar Sites 8

Impact of Socket Configuration on Immediate Implant Placements 14

Accepted Ways of Minimizing Peri-Implant Crestal Bone Loss with Immediate Implant Placements 16

Conclusions 17

References 17

2 Radiographic and Anatomic Considerations 25
Venessa Mendes and Trevor Thang

Introduction 25

Imaging Techniques 25

Cone Beam Computed Tomography 25

Radiographic Evaluation for Immediate Implant Placement 26

General Osseous Considerations 26

Alveolar Bone Thickness 26

Variations in Trabecular Bone Density 26

Nasopalatine Canal and Foramen 27

Middle Superior Alveolar Canals 29

Nasal and Maxillary Sinus Floors 30

Mental Foramen 30

Anterior Loop of the Inferior Alveolar Nerve 31

Mandibular Incisive Canal 31

Lingual Foramina 34

Tooth-Related Complications 34

Mandibular Canine Bifurcations 34

Conclusions 35

References 36

3.1 Immediate Implant Placement in the Maxillary Esthetic Zone 39
Henny J.A. Meijer, Vincent J.J. Donker, and Gerry M. Raghoebar

Introduction 39

Preoperative Screening 40

Implant Surgery in General 40

Immediate Implant Treatment in Combination with Immediate Provisionalization 40

Assessment 40

Diagnosis and Planning Procedures 40

Surgical Procedures 40

Prosthetic Procedures 41

Follow-up 41

Case Presentation One 41

Case Presentation Two 41

Case Presentation Three 48

Case Presentation Four 51

Discussion 53

Conclusions 54

References 54

3.2 Immediate Maxillary Premolar Implant Placement 56
Mehdi Valizadeh, Antonio Barone, Rossana Izzetti, Chiara Cinquini, and Celine Soon

Introduction 56

Sagittal Root Position and Bone Angulation 56

Maxillary Sinus Proximity 57

Case Selection 61

Intact Versus Non-Intact Socket 61

Suggested Surgical Protocols 61

Extraction 61

Attaining Bone Anchorage 61

Implant Selection 63

Soft Tissue Modification 65

Discussion 69

References 69

3.3 Challenges in Placing Multiple Immediate Implants in Anterior Maxilla 72
Douglas Deporter, Mohammad Ketabi, Richard Martin, and Ehsan Birang

Introduction 72

Case Selection 74

Further Sample Cases 76

Conclusions 81

References 81

4 Immediate Implant Placement in Mandibular Anterior and Premolar Sites 83
Stuart Froum, Deporter Douglas, Dai Lao Rodriguez, Mohammad Ketabi, and Benedetta Grassi

Introduction 83

Sample Cases 86

Case One 86

Sample Case Two 86

Conclusions 94

References 94

5.1 Minimally Invasive Guided Bone Regeneration Techniques for Hard and Soft Tissue Augmentation with Simultaneous Immediate Implant Placement 97
Mehrdad Lotfazar

Introduction 97

Tunneling 97

Intrasocket Guided Bone Regeneration 98

The Ice Cream Cone Technique 105

Conclusion 113

References 117

5.2 Immediate Implants Needing Traditional Guided Bone Regeneration 119
Douglas Deporter, Amir Moeintaghavi, and Mohammad Ketabi

Introduction 119

Sample Cases 119

Case One 119

Case Two 122

Case Three 122

Discussion 122

References 128

5.3 Immediate Implant Placement in Compromised Maxillary Anterior and Bicuspid Sites: Immediate Dentoalveolar Restoration with Osseodensification 129
José Carlos Martins da Rosa

Introduction 129

Immediate Dentoalveolar Restoration Technique 129

Case Selection 132

Discussion 133

Conclusions 139

References 139

5.4 Aesthetic Reconstruction of Severely Resorbed Alveolar Bone with Immediacy using Tenting Healing Abutments or Tooth Bone “Rings” 141
Dong-Seok Sohn

Introduction 141

Background 141

Autogenous Block Bone Grafting 141

Intraoral Distraction Osteogenesis 141

Sandwich Augmenting with Interpositional Bone Grafting 141

Split Bone Block Technique 142

Guided Bone Regeneration (GBR) 142

Soft Tissue Matrix Expansion Technique Using A Tenting Pole Technique 142

The Vertical Tenting Pole Abutment 142

Description of the Sohn Bone Builder Tenting Pole Approach 143

Using Vertical Tenting Pole Healing Abutments in a Maxillary Anterior Site 143

Case One 143

Case Two 146

Vertical Bone Regeneration Around Immediate Implants Using Demineralized Tooth “Rings” 152

Discussion 164

Conclusion 164

References 165

6 Soft Tissue Grafting with Immediate Implant Placement 169
Neda Moslemi and Mohammad Reza Talebi

Introduction 169

Evolution of Soft Tissue Grafting during Immediate Implant Placement 169

To Preserve/Improve Buccal Contour Convexity 170

To Prevent Peri-Implant Soft Tissue Dehiscence/Deficiency 171

To Preserve/Improve Interproximal Papilla Thickness/Height 171

To Minimize the Need for Buccal Flap Advancement 171

Should Soft Tissue Grafting be Considered as the Standard of Care in Esthetic Immediate Implant Placement? 172

Surgical Techniques for Soft Tissue Grafting 172

Scarf-Connective Tissue Graft 172

Scarf-Connective Tissue Graft versus Coronally Advanced Flap/Tunnel Technique plus Connective Tissue Graft 172

Tunnel Technique plus Connective Tissue Graft 172

Coronally Advanced Flap plus Connective Tissue Graft 179

When to Select Coronally Advanced Flap plus Connective Tissue Graft or Tunnel Technique plus Connective Tissue Graft? 179

Rotated Pedicle Palatal Flap (RPPF) 179

Why Perform Soft Tissue Grafting and Immediate Implant Placement in the Same Surgery? 186

How Stable Are the Results of Soft Tissue Grafting? 186

Conclusion 193

References 193

7 Anatomically Guided Immediate Implant Placement in Maxillary Anterior and BicuspidSites 197
Deporter Douglas, Quang Nguyen, and Mohammad Ketabi

Introduction 197

The Concept of Anatomically Guided Implant Placement 197

Discussion and Conclusions 204

References 210

8 Guided Surgery for Placing Immediate Implants using Standard Osteotomy Preparation or Osseodensification 213
Arndt Guentsch

Introduction 213

Digital Workflows in Implant Dentistry 213

Data Acquisition 214

Intraoral Surface Scan (IOS) 215

Virtual Treatment Planning 215

Data Manipulation 215

Registration of Cone Beam Computed Tomography and Intraoral Surface Scan 216

Virtual Tooth Extraction 216

Wax-up 220

Three-Dimensional Implant Positioning 220

Guide Design 222

Sleeve Selection 222

Basic Design Principles 222

Workflow for Guide Design 223

Guide Production 226

Guided Implant Surgery 227

Immediate Implant Placement with Customized Provisional or Healing Abutment 229

Immediate Implant Placement with Guided Osseodensification 230

Conclusions 239

References 239

9 Optimizing Immediate Loading with Immediate Implants 245
Adriano Piattelli, Luca Comuzzi, Alessandro Cipollina, Tea Romasco, Giulia Marchioli, Natalia Di Pietro, and Amirhossein Majidi

Introduction 245

History of Immediately Loaded Implants 245

Microstructure of Bone under Loading 246

Immediate Loading of Immediate Implants 247

Biconometric Concept and Navigated Surgery 247

Use of Dynamic Navigation for Immediate Functional-Loaded Immediate Implant Placement 254

Pre- and Immediate Postoperative Use of a Zinc-L-Carnosine Mouthwash 255

Use of Complex Magnetic Fields during Healing of Immediate Functional Loaded Immediate Implant Placements 260

Conclusions 261

References 262

10 Emergence Profile Following Immediate Implant Placement in the Esthetic Zone 265
Edwin Ruales-Carrera, Patrícia Pauletto, Lenin Proano, and José Luis Viteri

Introduction 265

Implant Selection and its Relation to the Emergence Profile 265

Implant Placement in the Esthetic Zone 266

The Emergence Profile Contours 266

Timing of Implant Placement and its Relation to Emergence Profile 267

Prosthetic Modification of the Emergence Profile 268

Transfer of the Emergence Profile 269

Restorative Materials and their Relation to the Emergence Profile 269

Conclusions 273

References 273

11 Immediate Implant Placement in Infected Tooth Sockets 275
Mahdi Kadkhodazadeh, Anahita Moscowchi, and Reza Amid

Introduction 275

Treatment Steps 280

Extraction of Infected Teeth 280

Complete Debridement of Tooth Extraction Sockets 280

Platelet Concentrations in Infected Site Implantation 280

Are Systemic Antibiotics Needed? 280

Assessment of Treatment Success 284

Complications 284

Conclusions 284

References 287

12 Angled Implant Design (Dual Axis Implants) in Immediate Implant Placement in the Anterior Maxilla 289
Mehdi Valizadeh, Dale Howes, Petros Yuvanoglu, Costa Nicolopoulos, and Stephen Chu

Introduction 289

Anatomy of Teeth, Alveolar Bone, and Sagittal Root Position 289

Apical Socket Perforation Rate 290

Cement-Retention Versus Screw-Retention and the Issue of Buccally Inclined Implants 291

Angle-Correcting Abutments and Angled Screw Channels 291

Subcrestal Angle Correction: Development of a Root Form Dual Axis Implant 292

Screw Loosening 295

Variable Platform Switching 299

Macro Hybrid Subcrestal Angle Correction Implant (Body Shift Concept) 299

Conclusions 300

References 304

13 Complications with Immediacy and their Management 309
Stuart Froum, Douglas Deporter, Nasrin Esfahanizadeh, Mohammad Ketabi, and Chih Hao Shyu

Introduction 309

Potential Complications 310

Excessive Bleeding 310

Buccal or Lingual Plate Perforations 310

Implant Misalignments and Malpositioning 311

Damage to Vital Structures 315

Esthetic and Soft Tissue Complications 318

Post-Treatment Infection 318

Conclusions 323

References 323

Index 327