Immediate Implant Placement in Molar Area without Flap Elevation: A Case Series of 15 Implants
Immediate implant placement into fresh extraction socket has become a predictable procedure since Dr. Schulte had described the procedure in 1978 and some researchers in 1990's had demonstrated no significant difference of osseointegration between immediately placed implants and conventionally placed ones. When combined with flapless technique in premolar and anterior tooth area, it gives surgeons great flexibility in terms of treatment time and number of surgical procedures. However, immediate placement into molar extraction socket inevitably creates a considerable size of gap between implant surface and alveolar bone which limits the use of flapless technique. This presentation describes the method of flapless placement immediately after molar extraction and possibility of this technique.
Materials and methods
Retrospective chart review revealed 21 implants in 18 patients have undergone flapless implant surgery immediately after molar extraction from 2012 to 2013. Exclusion of patients with follow-up period less than 10 months enrolled 15 implants in 15 patients. Cause of extraction, location of implant placed, initial stability measured by torque or resonance frequency analysis (RFA), kinds graft materials, adjunctive surgery, healing period before prosthetic restoration and follow-up period after prosthetic rehabilitation were collected.
Results
Causes of extraction were dental caries, periodontitis, tooth fracture and periapical lesion. 7 implants were placed on maxillary 1st molar area, 6 implants were placed on mandibular 1st molar area and the other 2 implants were placed on mandibular 2ndmolar area. Bone gaps were filled with various allograft materials without the use of barrier membrane. 4 implants were placed with bone-added sinus floor elevation through extraction socket. Initial insertion torque value was from 20Ncm to 40Ncm. RFA values of 7 implants were tested ranged from 53 to 74. All the implants were followed up from 10 months to 24 months and all were survived.
Conclusion
Although the short follow-up period and limited number of cases restrict the evaluation of the adequacy of this procedure, immediate implant placement without flap elevation appears to be an alternative to conventional implant surgery even in molar area. Further studies are needed to establish this technique as a routine procedure.
References
1. Bersani E, Coppede AR, de Paula Pinto Prata HH: Immediate Loading of Implants Placed in Fresh Extraction Sockets in the Molar Area with Flapless and Graftless Procedures: a Case series. Int J Periodontics Restorative Dent. 2010;30:291 9.
2. Bottini LP, Ricci L, Piattelli A, Perrotti V, Iezzi G: Bucco-Lingual Crestal Bone Changes Around Implants Immediately Placed in Fresh Extraction Sockets in Association or not With Porcine Bone: A Non-Blinded Randomized Controlled Trial in Humans. J Periodontol. 2012;29:[Epub ahead of print]