Dental implants are a treatment option for the rehabilitation of completely or partially Edentulism or toothlessness patients, without teeth or with the absence of some, with high long-term success. The approach of dental implant treatment has changed over time, from osseointegration (bone and implant union) to the need for stable esthetic restorations over time.We can find evicted teeth, without possible treatment, in the mouth of patients in many different clinical situations.
Traditionally, these teeth were extracted (extraction) before the placement of the implants and the alveolus (the bone after removing the tooth) was left to heal for several months up to a year. Even so, most patients are interested in replacing their teeth in the shortest time possible, reducing the timing gap between tooth extraction and implant placement.The acceleration of this process permits the placement of the implant the same day that the tooth is extracted, which is commonly known as immediate implants.
Therefore, the patients may have less surgical interventions and this dramatically reduce the treatment time. Another advantage of accelerating the process of implant placement is that the amount of bone and gingiva that is physiologically reabsorbed during the remodeling phase of the bone after extraction is reduced if the implant is placed at the time of extraction if biomaterial bone and gum is grafted, in addition to the provisional.
The choice of when is better to place the dental implant depends on different factors. For this reason it is very important to understand the changes that occur in hard and soft tissues after extraction and keep in mind the anatomy of the future implant bed. After the extraction of a tooth the bone undergoes a series of alterations both horizontally and vertically. These changes determine four different times of implant placement. Immediate implants are those that are placed on the same day of tooth extraction. We speak of an early placement with healing of soft tissues when the implants are placed in the first 4 to 8 weeks post-extraction and early placement with partial bone healing when placed at 12 to 16 weeks. Late implant placement occurs when the alveolus is completely cured after 16 weeks.
Changes in bone and soft tissue after tooth extraction are closely related to when the implants will be placed. Despite similar success rates in immediate, early and late implants, it is very important to know and understand the risk factors of each procedure. Therefore, it is essential to treat carefully each case to determine its moment of implant placement and follow the surgical and prosthetic protocols for each indication.
The choice of the moment of implant placement is not the only factor that affects the time of treatment until the patient has the prosthetic tooth on top of the implant. Another important parameter to consider is the oral and periodontal condition of the patient. Periodontal disease must be treated completely before implant placement. In addition, the patient should be followed over time to reduce the inflammatory rates that increase the risk of failure and biological complications of implant-supported prostheses.
Once the implant is placed, the prosthesis that it will support also has different placement times according to each particular case. Traditionally, after the placement of a dental implant it is necessary to wait for a period of 4 to 6 months of healing and osseointegration before placing the crown, bridge or denture. Nowadays, the use of immediate load implants is more frequent, where the implant and the provisional tooth are placed in just 48 hours. After the healing time of 2 months, the temporary teeth should be replaced by the permanent teeth.Immediate loading implants are a very useful type of implants in specific situations.
The convenience of the application of this treatment should be evaluated by the professional under the patient suitabilities characteristics for this type of treatment, the load of the conventional prosthesis can always be considered after two or three months, even if the treatment is a little longerthe sum of all these times will be different in each case and must be determined by the professional that has the knowledge of each of the indications of the procedures for a predictable result within the patient.
Currently, immediate implants can be placed with immediate loading, with the tooth in the mouth on the same day that the extraction of the tooth is made, or the implants can be placed late and be loaded after 2 or 3 months, thus being the most durable treatment.