Repair of bundle bone collapse with bone grafting
Immediate implant leads to
bone and gum loss over time
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Bone surrounding an immediate implant
collapses resulting in failure
This immediate approach to implant placement is no longer considered an appropriate standard of care because of the high incidence of unsatisfactory results and complications that lead to jaw deformity including additional tooth loss. If a tooth is to be extracted, it is critical that bone grafting be performed to prepare the site by increasing the bone volume prior to replacement with a dental implant. Efforts to skip the bone building process by immediate insertion of the implant will lead to bone collapse, esthetic nightmares, chronic tissue infection, and eventually implant failure.
For successful implantation, it is important to take the time required to complete the necessary steps to achieve a result that lasts.
The bone does not “see” the implant and therefore bone remodeling is not influenced by the implant device. Bundle bone was lost following implant installation due to the genetically programmed collapse. An implant is unable to substitute for a tooth immediately following removal and cannot meet the biologic demands or provide the essential blood supply required to retain the delicate bundle bone.
It is now well established that implant placement immediately into fresh tooth sockets results in loss of the outer bone covering the dental implant and the metal implant surface becomes exposed. This bundle bone collapse results in gum recession, esthetic concerns and ultimately implant failure (see below).
Genetically programmed bone collapse after tooth removal
Immediate implant placement has been abandoned by the leading specialists in the field of implant dentistry. Several studies have reported unsightly results due to bundle bone collapse and gum recession as soon as 6 months after implant placement (see Table below).
Clinical studies reporting immediate implant complications
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For the first 30 years of implant dentistry in this country, dental implants placed by surgical specialists enjoyed a reputation of excellence, predictability, and sustainability. Recently, this trend of success has been endangered by implant placement performed by inexperienced general dentists (non-specialists) who have not received formal surgical training in an American Dental Association (ADA) accredited residency program. Implant failure and jaw deformities are two common complications of improper implantation. In fact a recent 2014 article in the Journal of the ADA a study of implant placement by general dentists concluded that implants placed in general dental practices resulted in 7 times greater implant failure rates (20% implant loss) than those reported in studies conducted in specialty settings (only 2-3% implant loss). This definitive study examining implant placement by general dentists indicates patients should reasonably expect 1-in-5 dental implants will fail (access this JADA study using this link..http://jada.ada.org/article
Three to six years of specialized surgical training is required to effectively perform oral surgery and implant placement into bone. It is imperative to realize that the dental profession allows general dentists to perform a broad range of surgical procedures (much like the cosmetic surgery industry). Weekend classes or minicourses are not the kind of certification you should feel comfortable with from any practitioner within your healthcare team. Be assured of your practitioner’s level of ADA accredited surgical training, years of experience, and track record of success. This is the first benchmark in assuring that your dental surgical specialist is knowledgeable and capable of offering you a high standard of care.
The goal of AIE is to inform the community of the San Joaquin Valley about what is necessary for proper surgical placement of a dental implant into the bones of the skull. An informed public will be better able to make dependable health decisions and thereby avoid injury and jaw deformity.
Driven by a climate of economic decline, general dentists have tried to hasten implant placement by skipping essential treatment steps and using cheaper quality materials. In an effort to circumvent bone grafting, many general dentists have attempted to insert a dental implant into the bone socket at the time of tooth removal. This process is called immediate implant placement or “implants in a day.” Initially, it was believed that implant placement at the time of tooth removal would prevent socket collapse. However, recent clinical research has conclusively proven that placing an implant into a fresh socket cannot prevent collapse of the bony ridge.