Dental Tribune International

Dr Stephen Chen on principles for case selection in post-extraction implant placement

By Dental Tribune International
October 13, 2020

In aesthetically critical areas, the selection of the time of implant placement—immediate, early or late—can influence the outcome. In an upcoming webinar on 19 October, Dr Stephen Chen will describe current concepts in post-extraction healing. Prior to his online presentation, Chen, who is president of the International Team for Implantology, gave a brief preview of his topic.

Dr Chen, how does the time of implant placement influence the outcome in aesthetically critical areas?
The challenge lies in managing resorption of the alveolar ridge once a tooth is extracted. This results in resorption of the alveolar process and soft-tissue changes. Each time point after extraction has its specific treatment challenges that need to be managed in the correct way.

Dr Stephen Chen is an associate professor at the University of Melbourne’s dental school and owns a private periodontics practice in Melbourne, Australia. (Image: Stephen Chen)

What are some risk factors for the development of aesthetic complications?
For immediate implants, the main risk is soft-tissue recession caused by thin or missing facial bone, or malposition of the implant. For early implant placement, the risk is insufficient augmentation to reconstruct the contour of the ridge.

Will your webinar focus on single-tooth and/or multiple-tooth implants?
The webinar will focus on single-tooth implant replacement in the anterior maxilla, where aesthetic outcomes are important. The clinician must not only decide on the best time to place the implant post-extraction, but must also deal with the hard- and soft-tissue regenerative procedures that are necessary to achieve a good outcome that meets the patient’s expectations.

One week after immediate implant placement and immediate restoration with a provisional prosthesis. (Image: Stephen Chen)

Late implant placement is not convenient for patients, owing to the healing time of at least four to six months. However, what would be the clinical reasons for choosing this treatment option?
Late placement may be considered if the patient is undecided on whether to have an implant placed, or to have a different tooth replacement option. Late placement may also be considered if the patient is young and still growing, or if there are medical contra-indications. When late placement is selected, a socket graft for ridge preservation procedure is strongly recommended so that there is sufficient bone for an implant when the patient is able to proceed at a later time.

Definitive implant prosthesis three years after implant placement. (Image: Stephen Chen)

What are some of the typical indications for immediate and early implant placement? Immediate implant placement can be considered if the soft-tissue and bone phenotypes are thick and the facial socket is intact. If these conditions are met, flapless extraction and immediate implant placement can be considered. Under these conditions, an immediate provisional restoration can also be considered, provided the implant achieves sufficient initial stability.

Editorial note: The International Team for Implantology webinar, titled “Post-extraction implant placement: When immediate, when early and when late”, will be presented live on Monday, 19 October, at 12 p.m. CEST. Participants will have the opportunity to ask questions about the topic, as well as earn a continuing education credit by answering a questionnaire after the lecture. Registration on the Straumann Campus is free of charge.

 

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