Oral health is very important to maintain different functions such as proper chewing, digestion, phonation, appearance or smile and psychological well-being. The loss of one or more teeth, whatever their cause, can affect oral health, smile and appearance in general. The first reason why patients demand prosthetic treatments is because they affect their appearance, aesthetics, self-esteem and happiness.
There are three main options for replacing missing teeth: removable prostheses, fixed prostheses (or bridges) and dental implants. Removable prostheses currently have very few indications, sometimes as temporary or when there are economic reasons in terms of the patient financial situation. Dental implants offer the best long-term solution for the absence of total or partial teeth and if the patient take care of it, and the best relation cost-benefit.
Nowadays the indications for dental implants have expanded thanks to the advances in surgical techniques and biomaterials. The treatment with dental implants has been shown to be a predictable and successful procedure with values between 94 and 96% at 10 years. Implant placement protocols (at which time after the extraction of the tooth), and loading (placement of the tooth) on the implants have been varying over time obtaining faster and simpler treatment times. It has been more than 30 years since the placement of immediate implants in the alveolus postextraction, at the time of extraction, was described by Schulte and Heimke in 1976.
Immediate implants are described as the process which an implant is placed in the same surgical act as the extraction of the tooth that must be replaced. According to the time that elapses between the extraction and the placement of the implant, a classification has been established relating the healing of the receiving area and the therapy to be performed. The immediate implants are placed in the same act as the extraction or extraction when the remaining bone is enought to ensure the primary stability of the implant. Early implants are placed between weeks 4 and 8 when the soft tissue has healed or between weeks 12 and 16 when there is soft tissue healing and scarring of the bone. Finally, the late placement of an implant occurs after 6 months when the bone is fully healed. Currently no waiting time is necessary and the implants are placed at the time of extraction or after two months of waiting for healing.
The placement of immediate implants offers the following advantages: the number of surgical interventions is reduced, the duration of the treatment is shorter, a three-dimensional position of the ideal implant can be achieved, the preservation of the alveolar bone in the extraction zone, adding particles of bone biomaterial (bottle bone) and thus a better aesthetics of the soft tissues is achieved.
On the other hand, there are situations that have an adverse effect on the placement of immediate implants. These complications may be due to alveolus morphology (lack of bone where the tooth was) after extraction, presence of periapical pathology or infection, absence of keratinized tissue or fine biotypes.
Survival rates of immediate implants are similar to those of implants placed in fully healed bone. The preservation of the bone and soft tissue crest is not better following one protocol or another. In both cases the results are similar.
When an implant is placed in a larger diameter socket, a space remains between the implant and the bone wall. There is a consensus in using biomaterials to fill this space and the use of these materials shows a higher position of the gingival margin (gingiva). In the presence of chronic periapical infections, the placement of immediate implants is not contraindicated, but it is a risk factor. Adequate curettage of the alveolus is necessary and an evaluation by the clinician for implant placement.
The placement of immediate implants followed by the extraction of a tooth can be a viable alternative to late implants. They require a careful case selection and a specific treatment protocol since it is a technical-sensitive technique, more complicated to execute than the conventional placement of dental implants.