Case Selection Criteria for Predictable Immediate Implant Placement and Immediate Provisionalization

Abstract

Immediate implant placement and immediate provisionalization in the esthetic zone represents a therapeutic option particularly appreciated by patients. Reducing the number of surgical interventions and eliminating the need for a transitional removable prosthesis are clear advantages of this technique. However, performing this technique is not always possible and careful evaluation and case selection is crucial to achieve a predictable result. A 5-factor decision tree is presented in order to successfully perform immediate implant placement and immediate provisionalization or select a more appropriate treatment modality according to the different clinical situation encountered. Asmita Bhekare*, Mohamed Elghannam, Selina H Somji, Salvatore Florio and Takanori Suzuki Department of Periodontology and Implant Dentistry, New York University, USA *Address for Correspondence Asmita Bhekare, Department of Periodontology and Implant Dentistry, New York University, Clinic 5W, 345 E 24th St, New York, NY 10010, USA, Tel: +1-929 294 3785; E-mail: Arb719@ nyu.edu Submission: 15 January, 2018 Accepted: 20 April, 2018 Published: 27 April, 2018 Copyright: © 2018 Bhekare A, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Review Article Open Access Journal of Oral Biology Introduction When having to replace a failing tooth in the esthetic zone, a dental implant is a predictable and successful treatment option that does not involve the preparation of adjacent teeth [1-2]. However, when compared to tooth-supported prostheses, dental implants usually require longer periods of treatment. Following tooth extraction, 12-16 weeks is typically needed to obtain substantial clinical or radiographic bone fill of the socket in order to place an implant [3]. An additional 3-6 months of sub mucosal healing prior to functional loading are essential for its osseointegration [4]. During this time interval, a removable provisional restoration can be used to replace the missing tooth but oftentimes, patients do not tolerate such prostheses well. In order to reduce the duration of treatment, several variations to the conventional protocol have been reported in the literature [5-7]. The immediate implant placement and immediate provisionalization (IIPIP) technique involves placement of the implant immediately after tooth extraction and providing an implant-supported fixed restoration. Numerous studies have shown that IIPIP attains high success rates comparable with single implants placed in healed sites that are either immediately provisionalized or treated with the conventional delayed loading approach [8-16]. Patients particularly appreciate this solution since it reduces the number of surgical interventions and eliminates the need for a temporary removable prosthesis. Although the rationale behind immediate placement of Avens Publishing Group Inviting Innovations J Oral Biol April 2018 Volume 5 Issue 1 © All rights are reserved by Bhekare A, et al. Avens Publishing Group Inviting Innovations implants into fresh extraction sockets remains the same since it was reported by Gelb DA in 1993 the concept has evolved (Table 1) [17]. Establishing indistinguishable harmony between the restoration and the surrounding hard and soft tissues is crucial. However, achieving such a result may be challenging with IIPIP due to the hard tissue resorption and soft tissue recession that occurs [6,23-25]. Careful case selection and evaluation is therefore critical. The clinician must be aware of the biological and anatomical prerequisites that have to be met for IIPIP in the esthetic zone and select an alternative treatment option when these are not present or when intraoperative complications arise. Despite being well documented, current guidelines and classifications can sometimes be too simple for all the parameters to be covered or far too complicated for a clinician to make the judgment on whether to perform this technique or not [26,27]. The aim of this report is to guide the clinician with a 5-factor decision tree during the diagnostic and surgical phases of the treatment to predictably and successfully perform IIPIP on a maxillary anterior tooth. Materials and Methods A search of the literature was performed focusing on immediate implant placement and immediate provisionalization. Clinical data in this study was obtained from the anonymous Implant Database (ID) at the Ashman Department of Periodontology and Implant Dentistry at the New York University College of Dentistry. This data was Table 1: Change of concepts of immediate implant placement and immediate provisionalization. Author Year Change of concepts Gelb DA [17] 1993 Open flap, bone graft+membrane, submerged Wohrle PS [18] 1998 Atraumatic extraction and immediate provisionalization Kan JY [19] 2003 Flapless surgery Kan JY [20] 2011 Apico-palatal bone for primary stability Su H [21] 2010 Concave emergence profile Chu SJ [22] 2012 Dual-zone concept Citation: Bhekare A, Elghannam M, Somji SH, Florio S, Suzuki T. Case Selection Criteria for Predictable Immediate Implant Placement and Immediate Provisionalization. J Oral Biol. 2018; 5(1): 6 J Oral Biol 5(1): 6 (2018) Page 02 ISSN: 2377-987X extracted as de-identified information from the routine treatment of patients. The ID was certified by the Health Insurance Portability and Accountability Act (HIPAA) and approved by the University Committee on the Activities Involving Human Subjects (UCAIHS). A computer search of electronic database from MEDLINE and PubMed at the Waldman Library at the NYUCD was performed.