Postextractlon Placement of Implants
When implant placeentis planned before extraction of the tooth, consideration should be given to the most desirable time, for implant placement. The implant may be placed immediately (l.e., at the time of extraction), early (Le., 2 months after extraction), or late (Le., more than 6 months after extraction). Each of these times has its indications, advantages, and disadvantages . Immediate placement allows the overa l lshortest healing time and combines the tooth extraction with the surgical
implant placement. Immediate placement can be considered if the tooth to be removed is not infected and can be removed without the loss of -alveolar bone. Once the tooth Is removed the implant is p aced at least 4 mm aptcal
to the apex of the tooth (Fig. 14-65). The implant should be countersunk 2 mm below the height of the crestal bone to allow for resorption of the bone secondary to extraction. The gap between the implant and the residual tooth socket must be evaluated and managed according to its ‘size. If the gap is less than 1 mm, no treatment modification is needed. If the gap.is greater than 1 mm, the same type of guided bone regeneration may be necessary. After implant placement, every effort should be made
to achieve primary soft tissue closure. If this is not pos- . sible, a resorbable collagen pellet may be placed over the implant and held in place with a flgure-elght suture. The time for integration should be extended by 1 or 2 months. Even if the extraction site meets the requirements for
immediate imlant placement, it may be desirable to wait. If the socket is reconstructed with a graft, as little as 2 months is an adequate waiting period before implant placement. During this time the’ overlying soft tissue will heal and primary closure will be easier at the time of implant placement. This is generally long enough to allow remodeling of the socket and, in the case of multirooted teeth, some filling of the socket with bone. In this situation implants areplaced using the same technique described for routine implant placement. The bone in the area of surgery will be softer but generally will allow preparation of the implant recipient site with little modification. No increase in integration time is generally necessary in this situation. If teeth have been removed longer than 6 months, implant
placement should proceed with no modification in technique.