Innovative approaches in implantology.
From classic two-stage to immediate protocol.

Implant placement in the anterior region requires optimal bone conditions to allow for a 3-dimensional implant positioning that meets anatomical and aesthetic criteria. Following dental extractions, a phenomenon of post-extraction resorption is observed making implant placement even more difficult. This resorption is observed both vertically and horizontally and can cause a loss of more than 50% of the volume of the crest in the 6 months following the extraction making implant placement and soft tissue management around the future prosthetic restoration more difficult thus compromising the final aesthetic result.

Bone regeneration techniques and or soft tissue grafts are then indicated to recreate the gingival profile and make the aesthetic result reliable and durable.

To prevent the resorption phenomenon, several techniques have been advanced such as ridge preservation, guided bone regeneration, and immediate post-extraction implantation.

Ridge preservation following tooth extraction is a technique that has proven to be reliable in conserving bone capital and allowing delayed implant placement in optimal hard and soft tissue conditions. Several techniques have been advanced and different biomaterials have been proposed with satisfactory clinical results. However, this technique is performed in two stages over a healing period of several months thus delaying the final prosthetic restoration.

Immediate implant placement into extraction sites is a fast and reliable technique. This technique follows clinical steps and requires optimal bone conditions during implant placement to allow for implant stability. The buccal bone plate must be preserved through atraumatic extraction and the bone quantity must allow stabilization of the implant above the apex of the extracted tooth.

The placement of the implant must follow the rules of 3D placement to respect the aesthetic criteria while allowing primary stability. The pre-implant study with the help of planning software and the guided implant placement will allow an ideal position as well as a preliminary preparation of the temporary crown.

Implant geometry plays an essential role in allowing optimal stability allowing immediate delay that will guide bone and gingival healing while maintaining aesthetics during the healing period. Finally, the space between the implant and the vestibular bone table must be grafted to preserve the vestibular bone capital that will guarantee long-term tissue stability.

Recently, a new technique was introduced; the root membrane technique. The rationale behind this technique is to partially extract the root thus leaving the buccal part in contact with the buccal bone to preserve desmodontal irrigation to the latter.

This technique will be also exposed along with radiographic and clinical data monitoring tissue retraction at long-term follow-up.

During this hands-on session, socket preservation techniques will be exposed and new approaches for immediate implantation will be presented.

Recent clinical, histological, and radiological studies will be presented to provide a clinical and scientific justification for the dilemma that governs the management of extraction sites in oral implantology.

Learning objectives:

• Understand the importance of optimal implant positioning and early physiologic remodeling around implants.
• Recognize the resorption phenomenon following tooth extraction.
• Learn different ridge preservation techniques.
• Learn about immediate implant placement into extraction sockets and the importance of implant geometry choice.
• Comprehend the rationale behind implant immediate loading and temporization.
• Understand the importance of digital planning for placement and immediate temporization of dental implants.

Course outline:

• Ideal implant positioning to ensure esthetic results.
• Extraction socket physiologic remodeling and ridge preservation techniques.
• Immediate implant placement into extraction sockets: Surgical techniques.
• Implant immediate loading and temporization: what is the rationale?

Practical part:

• Interactive discussion and digital planning of an immediate implant placement case.
• Guided immediate implant placement into extraction sockets and immediate temporization (artificial model).

Duration: 8 hours.