Same day dental implants
Dental implants have many benefits. One of the most important is replacing a broken or damaged tooth in the front area that can no longer be restored.
broken front tooth that can no longer be restored
In this case, an implant crown offers a highly aesthetic and efficient solution as it avoids the need to prepare the adjacent teeth.
after tooth removal, a dental implant is placed to restore the gap
However, the traditional procedure can take up to one year as it implies three different steps:
Removal of the existing tooth or root. The extraction socket is left to heal for four to six months before a dental implant is placed. During this period, the body will grow new bone inside the socket.
The implant is surgically inserted into the jaw bone. A variable amount of healing time is required for osseointegration (3 to 6 months). Osseointegration is a biologic process where the implant forms an intimate bond to the bone.
After the healing time, a dental crown is attached to the implant.
Teeth in a day: Immediate placement and loading
Patient demand for immediate gratification has increased; as a result, implant dentistry has since responded with immediate implant placement after extraction followed by immediate loading of the crown.
Nowadays immediate loading is becoming far more common: the implant and temporary crown are placed within 48 hours of implant surgery and are left in position for the healing period.
Who is a candidate for immediate tooth replacement with implants ?
Immediate placement is not appropriate for all patients and cases and the screening process should be extremely thorough. The ideal candidate is someone who is in good dental and general health. Some factors can also negatively affect dental implants:
- any conditions that affect the immune system or reduce the body’s ability to heal
- some drugs such as bisphosphonates as these drugs increase the risk of bone death after surgery
- bruxism or teeth grinding and clenching
Patients who choose this approach must also be committed to good oral hygiene. Furthermore, not overloading the implant crown is another factor that needs to be reinforced with patients when loading an implant immediately after placement.
Patients with enough bone quantity and quality are great candidates for immediate placement and loading because of anticipated implant initial stability assuming that they would be compliant with postoperative instructions.
There are a number of issues and steps to consider:
1. Consultation and planning
Dental implant surgery has to be meticulously planned; when you opt for immediate implant placement, careful planning and experience are prerequisites for success.
Your dentist will need to know your complete dental and medical history before carrying out various diagnostic tests, such as dental x-rays and a CT scan.
The data from these tests must be analyzed to assess the quality of the bone that will be surrounding the dental implant. When an implant is placed into a recent extraction site, many doctors prefer to graft bone in the alveolar socket to create a bony base for the implant.
There should also be enough gum tissue to surround the implant and crown as this will affect aesthetics; the implant crown should look as if it is emerging naturally from the gums. Gum tissue can be grafted from another site in the mouth if necessary.
At this stage, the dentist will also determine the best position for the implant and will choose the correct size.
2. Removing the existing tooth
It is quite critical that your broken tooth is removed very carefully so that the tooth socket is not damaged.
If any bone from the walls of the socket is damaged or lost, it could lead to unsightly gum recession and/or a poor prognosis; in this case, many practitioners would prefer to end the procedure (and continue with the traditional approach) rather than risk a poor result.
3. Implant placement
Using this technique, the implant fixture is placed in the bone right after the tooth extraction.
It is vital to place the implant so that it is stable and non-movable in the bone. This stability is referred to as the primary stability of the implant.
Latest research suggests that the primary stability of the implant in bone is a more important determinant of the success of implant integration, rather than a certain period of healing time.
The tooth socket of an upper front tooth is cone-shaped. To achieve primary stability, the implant has to penetrate the apex of the socket (or the end point) and affix to the bone in this area (see image below). Additionally, a bone graft can be placed inside the tooth socket.
It is very important to select the right-sized implant for the situation and make sure that it is placed in exactly the right position.
4. Crown placement
The crown will be attached to the implant in one of two ways:
- Directly: the crown and the abutment are one piece and a lag-screw traverses both to secure the one-piece structure to the internal thread on the implant.
- Indirectly: first, the abutment is attached to the implant and the crown will be cemented to the abutment. In this variation, the abutment can be used to create a change of angulation for the crown to emerge through the gum tissue with a more natural appearance.
Regardless of the variation used, it is critical that the newly attached crown is free from biting forces, which could displace the implant. The crown is usually a temporary crown, made of a composite or acrylic resin, which can easily be modified to ensure that it is both functional and cosmetic.
Once the implant is fully integrated with the bone, the temporary crown can be removed and replaced with a permanent one.
5. Care and maintenance
Immediate implant placement and loading requires higher patient compliance. There are 3 key factors that patients have to consider:
It is vital that the implant restoration should not be overloaded as even micro-movement during the first two months of placement can result in non-fusion and failure of the implant to attach to the surrounding bone.
Avoid biting on extremely hard pieces of food and contact your doctor if you notice any signs of involuntary teeth grinding and clenching.
It is critical to take good care of the area around the implant for the first couple of months after the surgery in order to prevent infection.
If maintaining this level of care could be a problem, then you should consider traditional dental implants that use a two stage technique.
You may not be suitable for this type of treatment if you are a heavy smoker and have problems quitting smoking and tobacco products.
Benefits and risks of same day dental implants
Reduced treatment time
A traditional implant can take between six months and one year to completely restore, considering the tooth removal the starting point.
Same day implants are able to replace a front tooth almost immediately.
Only one surgical procedure is required
Tooth removal, implant placement, and crown attachment are all performed during the same visit. Consequently, there is no need to uncover the implant 3-6 months later in order to attach the abutment and crown.
Better aesthetic results are achieved regarding the gum tissue
With immediate placement and loading, the gum tissue can be shaped by the temporary crown. As a result, the gum tissue matches the permanent crown and better aesthetic results are achieved.
It avoids the need of temporary dentures or the “missing teeth” look
Since the implant crown is attached in the same procedure, there is no need to wear a removable denture or have gaps in your smile during the healing period.
Risks and drawbacks
Even the smallest movement increases the risk of failure
Same day implant placement is a very precise technique and the practitioner has to take all necessary measures to ensure the implant cannot move while integrating with the bone (the first two months).
The technique is only suitable in specific situations
As mentioned, same day implants are not appropriate for all patients and cases and the selection process is an important step of this treatment.
The implant surgeon has to be skilled and experienced
Same day implants cannot be performed by anyone. The surgeon has to be skillful and experienced enough to accurately place the dental implant so the risk of any micro-movements is eliminated.
First of all, it is very important that patients understand the risks, benefits, and alternatives regarding single tooth implant placement and timing. Same day implants can only be used in specific situations and patients need to be carefully evaluated for their suitability.
Preplanning and experience from the implant surgeon as well as thoroughly conducted care measures are required for the success of this technique. If you are not suitable for immediate dental implants placement, it is still worth considering delayed loading implants, even though treatment will take a little longer.
American Academy of Implant Dentistry: Dental Implants, Alternative Techniques
Dear Doctor, A Patient Education Company: Same-Day Tooth Replacement With Dental Implants
The National Center for Biotechnology Information: Role of primary stability for successful osseointegration of dental implants: Factors of influence and evaluation
Last review and update: May 2018