We have been teaching early implant placement as a superior implant methodology for about 2 years and it gives us great pleasure to find our customers refining and expanding the technology. Here we present a case performed by Dr. Matt Bickel, a general dentist in New Jersey who has been using our products for many years.
Patient is a 62 y.o. white female who presents with a fractured, endo treated, #30. Due to insurance issues, she was hoping to get the extraction, graft, implant, and implant restoration in approximately a 2-month time frame.
Early Implants: Pushing the Envelope onBone Regeneration
This is a preop slice of implant planning CBCT. You can see the crack and extent of the lesion on the M root.
Planned position of Hiossen ET3 5×11.5mm implant. Very little bone engaged apical to the lesion.
Another view of the planned implant position.
Tooth was extracted and grafted with Socket Graft Injectable on 10/28/2019. This low res CBCT slice is from the day of implant placement, 11/19/2019, just 3 weeks later. Cytoplast membrane was removed, and implant was placed fully guided. You can see calcification already starting in the socket.
Another view from day of implant placement just 3 weeks post extraction and graft. Again, you can see calcification already starting in the socket.
Implant post op CBCT. While the accelerated time frame is a major benefit to the patient, the largest motivating factor for the patient is that the implant is placed without incisions, flaps, and exposure of the bone and sutures. When the membrane is removed, the osteotomy is created and the implant is placed with a healing abutment level with the gingiva. Not only is there no post op pain, but the implant placement only takes a few minutes to perform.
Implant post op CBCT. He was able to achieve 35 NCm of torque, even with most of the implant in immature bone. While it is difficult to improve on this case. the implant could have been placed 1-2 mm deeper to allow for the healing abutment to be flush with the gingiva and to create an emergence profile near 30%.
This is the scan body radiograph taken 12/30/2019, just 2 months post ext/graft, and 5 weeks post implant placement. Bone is not fully mature yet, but ISQ reading was 74.
Day of screwmentable crown/custom abutment placement, 1/28/2020. Bone still not fully mature, but you can see the difference in density and level from the scan body radiograph a month earlier. Yes, #31 is slated to be replaced.
Here is the money shot from 3/11/2021 after 14 months in function. Bone fully mature and dense, and right up to the top of the fixture.
A comment by SteinerBio:
Comparing Immediate, Delayed, and Early Implant Placement
Immediate implant placement is common but has been shown to have a higher rate of complications and a higher rate of failure to integrate. In addition, when immediate implants are grafted with cadaver bone grafts, studies have shown that progressive bone loss occurs indefinitely: Retrospective cohort study of 4,591 dental implants: Analysis of risk indicators for bone loss and prevalence of peri-implant mucositis and peri-implantitis. Also, unless the immediate implant is temporized, the gingiva collapses, producing an esthetic defect.
Delayed implant placement has been shown to be the most successful and predictable method of tooth replacement. However, delayed implant placement also comes with a lengthy time to restoration and collapse of the gingiva. In delayed implant placement, the bone that contacts the implant needs to be resorbed before integration occurs, delaying implant integration.
Early implant placement overcomes the negatives of immediate and delayed implant placement. A main advantage of early implant placement is the maintenance of the gingiva producing excellent esthetic results. In addition, early implant placement places the implant into the regenerating tissue as socket mineralization is occurring. At the early time frame of 2-6 weeks, the socket is filled with an abundance of mineralizing osteoblasts that are not present after bone has formed, resulting in rapid improved integration. However, the main advantages are what the patient experiences clinically with shorter times to restoration, but mainly the implant placement is quick, painless, and with rapid healing. A patient who experiences an early implant placement as presented in this case will no longer accept delayed implant placement.
Dr. Bickel is a long term customer of SteinerBio but is not associated with SteinerBio. He is very willing to share his knowledge and if you have any question about this methodology, he can be reached at:
Dr. Matt Bickel
Dayspring Dental
428 Ganttown Rd.
Sewell, NJ 08080
www.DayspringDentalTwp.com
DrMatt@DayspringDentalTwp.com
MEMBER:
American Society for Bone and Mineral Research (ASBMR)
Tissue Engineering and Regenerative Medicine International Society (TERMIS)