Immediate transmucosal implants using the principle of guided tissue regeneration. I. Rationale, clinical procedures and 30‐month results.

Abstract

The installation of implants directly into extraction sockets offers considerable advantages over other treatment modalities for both practitioners and patients. Usually, immediate implants are placed and subsequently covered by mucosa allowing a submerged healing mode. This report presents the rationale, clinical procedures and results for immediate transmucosal implants. Following an intracrevicular incision and flap elevation, the tooth to be extracted is carefully luxated by means of small elevators to preserve the entire bony housing of the tooth. A titanium plasma-sprayed implant (ITI Bonefit) is then installed at the bottom or in the wall of the extraction socket. An expanded polytetrafluoroethylene barrier membrane (Gore-Tex GTAM) is tightly adapted around the implant post and over the bony margins of the alveolus. The flaps are then replaced, adapted around the neck of the implant and sutured. During nonsubmerged, transmucosal healing of the site, meticulous plaque control is performed by mechanical and chemical means. Membranes are removed after 5-7 months. Since infection was prevented, the implants obtained stability, healthy peri-implant mucosal tissues were observed and missing bone in the alveoli regenerated. Of 21 transmucosal implants placed into fresh extraction sockets, 20 yielded complete bone fill and coverage of the entire plasma-coated implants surface at the time of membrane removal. This documentation suggests that the immediate nonsubmerged installation of an implant into an extraction socket is a predictable treatment modality with good long-term prognosis.

Clinical Evaluation of Immediate Loaded Upper Anterior Single Implants

“…The success based on clinical criteria 45,46 has been experimentally documented by Akimoto et al, 47 who showed that small peri-implant defects up to 1 to 1.5 mm can be treated successfully with particulate autogenous bone alone, whereas in larger defects, the addition of a membrane may be needed.…”

“PASS” Principles for Predictable Bone Regeneration

“…50,72,73 A consensus has yet to be formed regarding the need for the use of barrier materials and/or bone grafts around immediately placed implants. [74][75][76][77][78] It may be that assuming the critical jumping distance has not been exceeded, the space formed between the extraction socket and implant fixture provides an ideal environment for clot stabilization and subsequent osteogenesis. 79,80 Various animal studies have proved that by excluding the epithelium and connective tissue, a secluded space is thereby created, allowing slowly migrating osteoblast cells to populate the wound, resulting in enhanced bone formation.…”

Immediate Loading of Modified Acid Etched Dental Implants in Postextraction Sockets: A Histological and Histomorphometrical Comparative Study in Nonhuman Primate Papio Ursinus

“…3,11 In clinical practice, 2 treatment protocols have been used for postextraction implant placement: the submerged protocol [12][13][14] and the nonsubmerged protocol. 15,16 However, these protocols have been progressively challenged to decrease treatment time, minimize the number of surgical procedures, and maximize esthetic outcomes. NowaPurpose: Immediate loading of dental implants inserted into fresh postextraction sites has recently been proposed as a novel but challenging surgical approach.…”