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16 | IDENTITY success is … evolution of a treatment method Immediate implant placement in the esthetic region | Dr. Steffen Kistler | Dr. Frank Kistler
Immediate implant placement, which is placement of an implant immediately after extraction of the old tooth, is a treatment method in modern implantology that does not involve increased risk during healing if a few basic rules are followed. Most publications describe long-term results that are practically identical with the success rates of later implant placement. This procedure has increasingly become the procedure of choice in implant therapy in the esthetically demanding front tooth region. Because immediate implant placement, preferably with immediate restoration, allows retention of the existing hard and soft tissue, demanding and high-risk treatment can often be avoided in achieving an esthetically and functionally satisfactory result. Of course, structures can only be retained and restored with this procedure. Therefore, improvements in methods are still being made to achieve an overall situation with long-term stability. Most parameters that affect a generally predictable result in the front tooth region have been known for some time. The “dos and don’ts” have been investigated in ever more detail starting with the probably most cited study by Tarnow et al. Retained proximal papillae are no longer a novelty, and also the question of the correct implant diameter is now clarified, after some initial confusion. IDENTITY | 17 What are the problems in achieving a result with genuine long-term stability after immediate implant placement? Several parameters are becoming increasingly important here. The first is certainly the long-term collapse of facial bone and soft tissue. For a long time little attention was paid to permanent prevention of vertical recession, also referred to as midfacial collapse, possibly because it is practically impossible to evaluate by x-ray. Discussion on the shape and material of the abutment most compatible with the soft tissue is also still continuing. On point 1: how can atrophy of the facial bone be prevented or minimized? The significant item here is the generally accepted opinion of implant diameter and occlusal position. Today, no one suggests implants with an alveolar diameter greater than D 5.5, because the resulting failures are well known. In contrast, the palatal displacement of the immediate implant compared to the extracted tooth is undoubted. However, beyond the positioning of the implant there is still no complete agreement on the question of whether the gap between the facial bone plate and the implant must be filled to provide stability against resorption. The actual dimension of the “jumping distance” of the bone is still being discussed. However, when considering esthetics leading colleagues in this field agree that the gap should be bridged.
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