Managing cases

Immediate approach

According to a recent meta-analysis of immediate implant placement and immediate loading in the aesthetic area (Del Fabbro et al. 2015), implants placed in a healed ridge had higher implant survival rates (99.4%) than implants placed immediately after extraction (95.6%). This result was also confirmed by another comparative metanalysis last year with similar figures (Mello et al. 2017). Although the late approach is still considered the ‘gold standard’, survival rates of immediate approaches are high enough to be considered a viable option in the aesthetic area, thereby minimising treatment duration and improving patient satisfaction.

But implant survival isn’t the only important factor. A meta-analysis of soft and hard tissue changes following implant placement found no significant differences between conventional (late) and immediate protocols (Yan et al. 2016).

“Implant survival isn’t the only important factor”

Another meta-analysis found lower levels of mid-facial recession when an immediate approach with immediate provisionalisation was used in cases involving thick biotypes than when a delayed restoration protocol was used or when the cases involved thin biotypes (Kinaia et al. 2017).

Long-term clinical data reported retrospectively by the author and co-workers (Testori et al. 2017) found that immediate loading does not negatively influence the prognosis of immediate post-extraction implants.

“Immediate loading does not negatively influence the prognosis of immediate post-extraction implants”

One of the problems with immediate implant placement is that the sockets could potentially be infected. In this regard, weighted evidence suggests that implants can predictably be placed in sites with periapical and periodontal infections, provided that the socket is thoroughly debrided and decontaminated (Waasdorp et al. 2010; Chrcanovic et al. 2015). Last year, comparative results were published after a follow-up of four and a half years yielding results no different for post-extraction implants in infected sites than in non-infected sites (Zuffetti et al. 2017). A meta-analysis published this year came to the same conclusion concerning the aesthetic area, with no significant differences in survival rate and hard and soft tissue changes found between infected versus non-infected sockets (Chen et al. 2018).