This paper is a follow-up to a recent systematic literature review with metaanalysis of outcomes when using immediate molar implants (IMIs). An attempt has been made to offer guidelines to assist clinicians in their successful use of this treatment approach. The surgeon's ability, proper case selection, socket anatomy, and specific modifications in osteotomy preparation all are crucial in avoiding errors, complications and implant failure. While long-term data are sparse, IMIs appear to be a viable treatment option if the offered guidelines are strictly followed.Keywords: Tooth extraction; Dental implantation; Endosseous; Guided tissue regeneration
IntroductionWe have recently published a systematic review and metaanalysis of literature published from November 2008 to May 2015 reporting outcomes following immediate molar dental implant (IMI) placement [1]. The search format was that recommended by the Academy of Osseointegration Workshop on the State of Science on Implant Dentistry (SSID) [2,3]. The search language used was similar to that employed in a previous review conducted by others on IMI data up to October 2008 [4]. Criteria for qualification of studies to be included in the analysis were: i) at least 10 IMIs; ii) minimum followup 1 year in function; iii) clearly reported/interpretable survival and/or success (based on crestal bone loss) data; and iv) use of rootform, solid, titanium or titanium alloy implants. Fifteen publications fulfilling these criteria were identified, none of which were doubleblind, randomized, controlled prospective clinical trials. Recognizing this limitation, our analysis supported Atieh's earlier conclusion [4] that it is possible to obtain good outcomes with IMIs with the added proviso that those of diameters >6 mm may be at greater risk of failure.There are obvious advantages for patients and clinicians in providing immediate implant replacement of molar teeth. These include fewer and potentially less invasive surgical procedures, greater patient acceptance, less chair time, lower treatment fees, shorter treatment times, and potentially fewer risks. The clinician needs to be aware, however, that achieving success with IMIs is affected by many factors. In the present paper, we have attempted to formulate guidelines for the successful use of IMIs. Considerations will include case selection, reason for extraction, quality and quantity of keratinized tissue, socket anatomy and how it impacts osteotomy preparation, implant design, and initial implant stability.
Discussion
Case selectionAs with all technique-sensitive surgical procedures, not all clinicians will be capable of successfully employing IMI procedures because of infrequent usage of the procedure, failure to follow