Mastering Immediate Implant Placement: The 10 Keys to Long-Term Success
The rising demand for immediate tooth replacement has pressured clinicians to provide quick solutions, but without proper planning, these can lead to failures. This article outlines 10 essential keys for achieving optimal esthetic and functional outcomes in immediate implant placement, ensuring long-term success and patient satisfaction.
Consumers now demand and expect same-day or next-day delivery of goods and services, and this is also true for patients seeking dental treatment. Fueled by extensive marketing, the rising popularity of immediate tooth replacement has led some clinicians to feel pressured into providing immediate implant placement and temporization. Simultaneously, patients expect near-perfect esthetic outcomes, with the final restoration appearing indistinguishable from the surrounding teeth. Without adequate patient selection, treatment planning, and setting realistic patient expectations, immediate implant placement and restoration can easily lead to esthetic and biological failures,1 along with patient disappointment, frustration or aggravation.
In 2017, Levine et al2 introduced the “10 keys,” an evidence-based treatment algorithm for successful and predictable placement of immediate implants in the esthetic zone. The updated 10 keys address the major pre-, peri- and postoperative aspects of immediate implant placement and temporization that promote optimal long-term esthetic and functional success. The 10 keys for successful esthetic-zone single immediate implants are as follows:
- Esthetic risk assessment
- Preoperative cone beam computed tomography (CBCT) assessment, with virtual surgical and restorative-driven treatment planning. Additionally, an appropriately sized and positioned implant is chosen to allow for a buccal gap > 2 mm
- Minimally traumatic tooth extraction, without flap reflection (if possible), with evaluation of the buccal and palatal plate status post-extraction (if there is any buccal height loss, other treatment options should be considered)
- Three-dimensional implant placement in good available bone, positioned along the palatal wall with an anticipated buccal gap > 2 mm
- Use of a narrower, 3.3- to 4.3-mm-diameter implant allowing for a > 2-mm-wide buccal gap and good primary stability
- Bone grafting of the buccal gap with a low-substitution-rate bone material
- Buccal soft tissue grafting using a subepithelial connective tissue graft (CTG) or a volume-stable collagen matrix
- Immediate contour management of the soft tissue emergence profile using a customized healing abutment or temporary crown
- Use of a custom impression coping technique to duplicate the created transition zone
- Final restoration with a screw-retained crown (when possible)
To achieve optimal esthetic outcomes, all 10 keys must be followed in sequential order, and if one of the surgical keys is unable to be completed, immediate implant placement may be aborted. Otherwise, the long-term hard and soft tissue stability or esthetic outcome may be compromised to certain degree.
References
- Tonetti MS, Cortellini P, Graziani F, et al. Immediate versus delayed implant placement after anterior single tooth extraction: the timing randomized controlled clinical trial. J Clin Periodontol. 2017;44:215–224.
- Levine RA, Ganeles J, Gonzaga L, et al. 10 Keys for successful esthetic-zone single immediate implants. Compend Contin Educ Dent. 2017;38:248–260.
This information originally appeared in Robert A Levine, DDS, Jeffrey Ganeles, DMD, David P. Semeniuk, BDSc, MS, Debora R. Dias, DDS, MSc, Ping Wang, BDS, PhD, DMD, Harry Randel, DMD and Maurício G. Araújo, DDS, MSc, PhD. Immediate Implant Placement With Virtual Planning in the Esthetic Zone. Decisions in Dentistry. January 2022;8(1):9-12.
