2001 immediate implant
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Transcript of 2001 immediate implant
Various studies of implant
指導老師 吳逸民醫師
2001/2/4 perio-prostho seminars
Topic
Immediate implant vs delayed immediate implant ( 王英斌 )
Wide-diameter implant vs standard-diameter implant ( 蘇娟儀 )
Single-stage vs Two-stage ( 黃文慧 ) Immediate loading vs progressive
loading ( 林偉祺 )
Bränemark group – traditional protocol recommends a 12-month healing period between tooth extraction and placement of implants.(Adell R et al 1981 Int J Oral Surg)
Preserve alveolar bone concept
immediate implant concept
Schulte(1984) Tuebinger implant Frialit-2 implant
Stepped-tapered root analog
Immediate implant
Advantage Preservation of the alveolar bone Esthetic (extracted tooth has a desirable alignment) ideal implant position natural scalloping and distinct papillae are easier to achieve maximal soft tissue support Fewer surgical interventions Reduction in treatment time & cost
Immediate implant
Disadvantages Misalignment of the extracted tooth may lead to
unfavorable angulation of the fixture Stabilization may require more bone than is
available beyond the apex Localized peri-implant bone defect Primary soft tissue closure
( submerged vs transmucosal implant)
Indication for Immediate implant
Root fracture Trauma not affecting the alveolar he
alveolar bone Decay without purulence Endodontic failure Severe periodontal bone loss Residual root
Contraindication for Immediate implant
Presence of pus Lack of bone beyond the apex or close
relationship to the anatomical vital structures
Extraction site defects
Residual defect morphology and the regenerative potential at the extraction sites
Salama H & Salama M
1993 IJPRD
Extraction site defects
Type I –ideal site for immediate implant 4-/3-wall socket with minimal bone
resorption (<5mm apico-coronal defect) Sufficient bone available beyond the apex Acceptable discrepancy between the
fixture head & neck of the adjacent teeth Manageable gingival recession or
esthetics is not essential.
Extraction site defects
Type II – need orthodontic extrusion Dehiscence > 5mm Substantial discrepancy between the
fixture head & neck of the adjacent teeth Significant gingival recession or
esthetics .
Extraction site defects
Type III –not suitable for immediate implant
inadequate vertical &B-L bone dimension Recession and severe loss of labial bone Severe circumferential and angular defect
The decision to submerge should base on the following factors
Plaque control Smoking Periodontal conditions The degree of stability The presence of provisional removable
denture
Submerged implant
Primary closure
Bowers & Donahue(1988)
Edel (1995) ,Chen & Dahlin(1996)
Rosenquist(1997)
Rotated palatal flap for
immediate implant
Nemcovsky CE 2000 COIR
Transmucosal immediate implant
Cochran & Douglas(1993);Brägger et al (1993) Schultz(1993) ;Lang(1994) Brägger et al (1996);Hämmerle et al (1998)
Evidences emphasize the importance of infection control for a successful tx. of outcome following immediate implant of transmucosal implants
Transmucosal immediate implant
Original peri-implant defect was the most critical factor relating to the final amount of bone-to-implant contact
Horizontal defect dimensions of >4mm resulted in a lower bone-to –implant contact than dimension of 1.5mm or less
Wilson et al 1998 JOMI
Conclusion about immediate implants
High survival rate : 93.9%-100% Implants must placed 3-5mm beyond the
apex in order to gain a maximal degree of stability
Implant should be as close as possible to the alveolar crest(0-3mm)
Schwartz-Arad D et al 1997
Conclusion about immediate implants
There is no consensus regarding about the need for gap filling and the best graft materials
The use of membrane does not imply better results –on the contray ,membrane exposure may carry complications
The absolute need for primary closure Schwartz-Arad D et al 1997
Immediate vs non-immediate
implantation for full-arch fixed reconstruction following extraction of all residual teeth : A retrospective comparative
study
Schwartz-Arad D et al 2000 JP
Results
5-year cumulative survival rate(CSR)
Immediate implant (96%) non-immediate(89.4%) Mean potential contact area(PCSA) 230mm2
Significant differences in CSR in maxilla(96.6% vs 82.9%)
Posterior Max.
Immediate implant (100%) non-immediate(72%)
Conclusions
Survival rates of implants placed to support full-arch ceramo-metal prosthesis can be ranked as follows : bone quality , immediate implant,PCSA
Immediate implantation exerts its effect through higher PCSA values by a compensatory effect for bone quality
Immediate implant does not carry additional morbidity
Delayed Immediate implant
To allow primary soft tissue healing following tooth extraction for a period of 6-10 weeks ,prior to implant placement
Advantages 1) adequate soft tissue 2) minimized the effect of microorganism
associated with the failed tooth or wound healing (Gher 1994)
3) highly osteogentic activity
Spontaneous in situ gingival augmentation
Burton Langer IJPRD 1994;14:525-535
Delayed immediate implant
Alveolar bone changes during the healing period Strong tendency for the defects to fill-in in the
horizontal plan and bone growth to occur in the vertical plane of the height of the cover screw .
Good short-term prognosis with bone regeneration occurring around the defect without the use of barrier membranes or bone substitutes
Nir-Hadar O et al (1998)
After an average follow-up of 12.4 months, peri-implant pocket depth, the gingival index, the hygienic index, and the degree of bone resorption were examined. A life-table approach (Kaplan-Meier) was applied for statistical analysis, and showed no difference between primary and secondary immediate implants. Also, none of the parameters examined demonstrated a statistically significant difference between the two groups.
Mensdorff-Pouilly et al 1994 JOMI
However, compared with the groups of secondary immediate implants, the group of primary immediate implants showed a tendency towards deeper pocket formation and an increased frequency of membrane dehiscences that may be due to the poorer quality of the soft tissue covering.
Mensdorff-Pouilly et al 1994 JOMI
3-year Prospective Multicenter Follow-up
No clinical difference with respect to socket depth or when comparing the different placement methods.
Higher failure rate was found for short implants in the posterior region of maxilla .(extracted for periodontitis)
Mean marginal bone resorption : (from loading to 1yr F/U) Max.(0.8mm),mand(0.5mm)
Implant survival : Max(92.4%);Mand(94.7%) Grunder U et al 1999 JOMI
Generally,
primary immediate implant –
max. anterior
secondary immediate implant –
mandible,posterior maxilla
Mensdorff-Pouilly et al 1994 JOMI
Thanks for your attention!!
Evidence for osseointegration of immediate implant
Experimental animal studies (Kohal et al 1997)
Controlled human studies(Palmer et al 1994)
Evidence for osseointegration of immediate implant
Root-analogue titanium implants
Lundgren et al (1992) beagles dog study
Kohal et al(1997) monkeys
Evidence for osseointegration of immediate implant
Conventional screw- or cylinder-type implant
Experimental animal studies
Parr et al (1993) dog study
Barzilay et al (1996) controlled monkey
Similar result for immediate and late implant ( Clinical,radiography,histology)
Evidence for osseointegration of immediate implant
Clinical studies Becker et al(1998) prospective clinical
human trials of 47 immediate implants without bone augmentation
cumulative success rate of 93% followed between 4 to 5 years
Bone augmentation in combination with immediate implant
GBR-barrier membranes
Experimental animal studies
Dahlin(1989)– rabbits
Becker et al (1991) – barriers enhance predictability of bone fill in immediate extraction sockets when compared with
a mucoperiosteal flap
Bone augmentation in combination with immediate implant
GBR-barrier membranes e-PTFE membrane
Lazarra(1989)
Becker &Becker(1990)
Nyman(1991)
Hammerle(1998)
Bone augmentation in combination with immediate implant
GBR-barrier membranes e-PTFE membrane Becker (1994) 49 immediate implant
with e-PTFE alone
--- 93.6% bone fill ,1-year functional loading success rate 93.9%
Bone augmentation in combination with immediate implant
GBR-barrier membranes e-PTFE membrane Gher et al (1994 ) influence of original defect morphology on bone
fill with e-PTFE at immediate implant sites Dahlin et al (1995) prospective multicenter study 2-year cumulative survival rate Max.(84.7%) mand(95%)
Bone augmentation in combination with immediate implant
GBR-barrier membranes Collagen membrane( Cosci&Cosci 1997) polyglactin (balshi 1991) Polylactic acid (Lundgren 1994) Fascia lata (Callen & Rohrer 1993) Autogenous gingival grafts(Evian & Cutler
1994)
Bone augmentation in combination with immediate implant
GBR-barrier membranes Zitzmann et al (1997)
e-PTFE vs collagen ( deproteinized bovine bone )
no significant difference in average percentage bone fill for collagen (92%) and e-PTFE(78%) But, 44% wound dehiscence and premature membrane removal in the e-PTFE group was reported.
Barrier membrane exposure
Compromised results
Simion (1994) bone fill (97% vs 42%)
Augthun(1995) Successful bone regeneration & complete bone
filling ,but strict infection control is followed
Mellonig (1993)
Shanaman(1994)
Rominger & Triplett (1994) 96.8%
GBR and bone grafts
DFDBA ( negative ) animal study
Becker (1992) dogs study
Becker (1995) dogs study
Kohal(1998) dogs study Clinical study
Gelb(1993)
GBR and bone grafts
DFDBA ( positive )
Callan (1990)
Mellonig (1993)
Landsberg (1994) combined with Tc
Gher (1994)
GBR and bone grafts
Hydroxyapatite
Wachtel et al (1991) biopsies taken on
3M showed enhanced bone regeneration
than non-grafted sites.
Knox (1993)
Novaes & Novaes (1993)
GBR and bone grafts
Simion(1994)
Cosci & Cosci(1997)
Fugazzotto (1997)
Schwartz-Arad & Chaushu(1997)
Compromised sites –infection
Pecora(1996)
32 teeth due to root fx.,perforation,endo-perio complication ,F/u 16M
Rosenquist & Grenthe(1996)
periodontal disease (92%)
trauma,root fx.,endodontic failure (95%) Novaes(1995,1998)
Compromised sites –infection
“ Immediate implantation at chronically infected sites may be successful,the extent of the defect ,the implant primary stability,and esthetic consideration of future restoration must be considered.”
Biologically active bone-differentiating substances
Cook (1995) recombinant human osteogenic protein-1(rhOP-1)
Cochran et al(1997) recombinant human bone morphogenetic protein-2(rhBMP-2)
Hedner & Linde(1995) membrane + BMP compromised blood supply
Future about biologically active bone-differentiating substances
Identification of the ideal carrier substrate Dose application The effect of combination
Late implants
A period of >6 months for healing of the extraction site is recommendation prior to implant placement