20 April 2023

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Immediate implants after extractions for dental trauma in the aesthetic sectors

Lara Figini

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After extractions for dental trauma, the labial wall undergoes the highest degree of resorption and the nature of the impact itself can cause further trauma to the alveolar bone and soft tissue, resulting in non-negligible horizontal and vertical bone atrophy.

Therefore, prior to implant placement, it may be indicated to perform soft tissue augmentation or a thickening treatment to compensate for the marked bone resorption and scar tissue that may develop following dental trauma injury.

Immediate placement of the implant in the extraction sites can provide advantages, the main ones being the least number of surgical interventions to be undertaken, a reduction in the overall treatment time and better maintenance of the soft tissues.

Although in theory, immediate placement could prevent oral hard tissue resorption that can follow tooth extraction, literature studies have demonstrated that changes in alveolar ridge morphology can still occur despite these placement protocols.

Materials and methods

In a retrospective study, published in the British Dental Journal in February 2023, the authors evaluated the clinical outcomes of implants immediately placed at extraction sites in the anterior maxilla following dental trauma.

Researchers included 60 patients, all at least 19 years of age, healthy and free from oral and periodontal disease, in the study.

Following a delayed loading protocol, clinicians restored the implants with definitive single crowns or bridges.

The immediate implants were left to heal for four months. After that time, clinicians checked their stability with a probe and light digital pressure, without local anesthesia, to see if the patient had kept the gingival tissues clean and healthy and without inflammation.

If there was gingival overgrowth that had gone to cover the healing abutment, this was removed under local anesthesia before taking the impression for the prosthetic device.

During the follow-up, implant and prosthetic survival, the dental team recorded complications and periodontal health.

Results

Seventy implants were placed in the anterior maxilla. Three failures were reported, with a survival rate of 95.7% over a three-year follow-up period. No additional bone graft was undertaken, and the prosthetic survival recorded was 100%, with favorable periodontal outcomes achieved overall.

Conclusions

From the data of this study, researchers concluded that implants placed immediately in the extraction sites after a dental trauma constitute a predictable treatment strategy, presenting high survival rates of the implant at three years of follow-up.

Hirani, M., Moshtofar, Z., Devine, M. et al. "Survival of immediate implants replacing traumatised teeth in the anterior maxilla." Br Dent J (2023). https://doi.org/10.1038/s41415-023-5504-7.