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Chapter 5 Surgery Phase Planning 97
Table 5.1. Protocols for implant placement in extraction sockets and their advantages and disadvantages.
Classifi cation Defi nition Advantages Disadvantages
Type I Implant placement
immediately
following tooth
extraction and as
part of the same
surgical procedure
Type II Complete soft-tissue
coverage of the
socket (typically
4–8 wks)
Type III Substantial clinical
or radiographic
bone fi ll of the
socket (typically
12–16 wks)
Type IV Healed site (typically
>16 wks)
Reduced number of
surgical procedures
Reduced overall
treatment time
Optimal availability of
existing bone
Increased soft-tissue area
and volume facilitates
soft-tissue fl ap
management
Resolution of local
pathology can be
assessed
Substantial bone fi ll of
the socket facilitates
implant placement
Mature soft tissues
facilitate fl ap
management
Clinically healed ridge
Mature soft tissues
facilitate fl ap
management
Site morphology may complicate
optimal placement and anchorage
Thin tissue biotype may
compromise optimal outcome
Potential lack of keratinized mucosa
for fl ap adaptation
Adjunctive surgical procedures may
be required
Procedure is technique-sensitive
Site morphology may complicate
optimal placement and anchorage
Treatment time is increased
Socket walls exhibit varying
amounts of resorption
Adjunctive surgical procedures may
be required
Procedure is technique-sensitive
Treatment time is increased
Adjunctive surgical procedures may
be required
Socket wall exhibit varying amounts
of resorption
Treatment time is increased
Adjunctive surgical procedures may
be required
Large variations are present in
available bone volume
From Hammerle CH, Chen ST, Wilson TG, et al. 2004 Consensus statements and recommended clinical procedures
regarding the placement of implants in extraction sockets. Int J Oral Max-illofac Implants 19(Suppl);27; with
permission.
brane were utilized in treating the apical fenestrations
and HDD. All implants were loaded
at 3 months and observed for 12 months with
a 100% success rate. The authors concluded
that a critical aspect of the treatment was
assessing the diameter of the periapical lesion.
If the lesion exceeded the diameter of the
planned implant, then there was a need to
obtain primary stability in an apical direction.
In these situations, the use of CT diagnostics
may assist the clinician in treatment
planning for either an immediate or delayed
placement protocol.
Treatment planning for immediately placed
dental implants in infected sites should assess
aesthetic risk factors as described by Morton
et al. (2008) (Table 5.2).
The following sequence of photographs
demonstrate the treatment process (Figs.
5.18–5.30).
Following the extraction and implant
placement, suture removal is accomplished
at 10 days with plaque control/home care
consisting of lightly wiping the area with a
cotton swab immersed in 0.12% chlorhexidine
digluconate. At 12 weeks the healing
cap can be accessed via a small gingivectomy
if necessary to allow fi xed provisionalization
and completion of the restorative
work.