Monday, December 14, 2009

Implant (No) Surgery

Most implants are placed into bone which has already healed over the extraction socket. This requires surgery. The gums have to be cut, a flap retracted and bone has to be drilled. The retraction of a gum flap almost always results in some pain and swelling.

To make the surgery less invasive, some dentists do it flapless. In other words, they drill straight through the gums into the bone without cutting and reflecting a flap. After the flapless operation, the patient tends to feel less pain. However, flapless surgery is “blind”. The surgeon will not be able to see if there are any perforations beneath the gums. Where bone thickness is not ideal, flapless surgery may not be safe or even possible.

What about inserting an implant into an extraction socket immediately after the extraction? If possible, the advantages are obvious. First, the patient does not have to go through implant surgery at a later date. It is flapless and relatively atraumatic. It is usually a one-stage surgery where no further surgery is required to expose the implant. As implants take 2-3 months to integrate, placing it at the time of extraction shortens healing and restoration time.

What is not so obvious, is the technical difficulty of placing an implant into an irregularly-shaped socket. When you drill a hole into a clean wall, you can control the exact depth and width of the hole. When you drill into an existing hole, it’s very difficult to control the final shape and size of that hole. It is imperitive that the surgeon gets good primary stability and is able to place a wide, socket width healing abutment over the implant at the end of the surgery. The success of immediate insertion depends very much on the surgeon’s skill and experience. It also depends on the condition of the tooth.

Immediate placement is not recommended when.

1. There is pus and acute infection.
2. The tooth is very shaky with advanced gum disease.
3. Surgical removal of the broken tooth is necessary.

The conditions for immediate placement are very similar to the conditions for required for socket preservation with Alvelac bio-scaffold. As long as the socket is walled with bone on all sides, immediate implant insertion is possible. Forget about socket preservation. The immediate placement of the implant provides socket preservation, fewer surgeries and shorter healing time without additional costs.

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