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Immediate Implants

As technology improves, so do your implant options

A Consultation with Dr. David A. Gelb

Dental implant assembly.
The above illustration shows the assembly necessary to restore an implant with a crown. The assembly consists of an abutment with a screw that fits into the implant and a permanent crown which is then cemented onto the abutment.

Dear Doctor,
I am about to lose a front tooth that broke at the gum line. I'm getting married and need to have a permanent replacement soon. My dentist said an implant could be done and a crown placed right away but it might be risky. Am I being shortsighted by going ahead with it?

Dear Jennifer,
I have to assume that since your dentist has mentioned what sounds like an “immediate” implant and crown to replace your tooth, he knows that this treatment option will probably work for you. An immediate implant requires planning and skill, in fact it requires team work between you the patient — restorative dentist, implant surgeon and laboratory technician.

There is no question that given the current state of the art in dentistry, that dental implants are pretty much the best way to replace teeth; they are stand alone tooth replacement systems that look and function just like natural teeth. They do not attach to adjacent teeth like a fixed bridge and don't have to be taken in and out like removable partial dentures.

A dental implant is a tooth root replacement made of titanium, which has the unique property of being osteophilic (osteo-bone, philic-loving) and actually fuses to bone. A crown, the part of the tooth that you see in your mouth, is attached to the implant. And the great thing about implants is they are not susceptible to decay or periodontal (gum) disease in the same way that teeth are.

Now here are a few important pointers, which hold for implants generally and are especially important in your case when replacing a front tooth for an imminent event like a wedding in which you need to look your best.

Your dentist is probably suggesting placing an implant directly into the extraction socket immediately following tooth removal. It is imperative that the extraction of the failing tooth be performed very carefully and without damage to the surrounding gum and bone tissue. This is known as an “immediate” replacement implant. Traditionally the socket is allowed to heal and fill in with new bone first before an implant is placed into it.

Fractured tooth
A photograph showing a fractured tooth broken off at the gum line.
Immediate implant
A photograph showing an immediate implant and the abutment replacing the fractured tooth.
Final crown
A photograph showing the final crown on top of the implant 3 months after the original surgery.

The benefit to having an implant placed “immediately” is that only a single surgical procedure is necessary as opposed to two separate procedures. Implant success is dependent upon initial stabilization and immobilization in the bone, meaning there should be no movement of the implant at all. This is critical to the fusion of the implant with the bone. Initially, the implant is held securely in place by mechanical forces. As the implant heals, it forms a microscopic bond with the surrounding bone which is known as osseo-integration (osseo-bone, integration – to become one with).

It is more difficult to place and secure an implant at the time of tooth extraction because there is less bone available, and the security comes from being able to fit the implant as closely as possible into the remaining socket and to the bone beyond it (where the extracted tooth root ended). This is especially important in the front of the mouth where the teeth show more in what we dentists call the “esthetic zone.” The procedure carries some risk, but is quite predictable in the hands of an experienced surgeon.

A crown, usually “provisional” in nature can also be placed immediately. This makes it all the more critical to have an initially stable, non-movable implant, because a crown placed immediately will tend to destabilize the implant with biting forces. The provisional crown therefore needs to be made so that it really doesn't contact the teeth in the opposing jaw so you can't bite or eat on it for a period of time — this means the new tooth is initially there just for social appearances. We call it a “provisional” crown, since we need to wait until we know that the implant has fully osseo-integrated, a matter of 2 – 6 months, before making a final permanent crown. That way we can be assured that not only the bone, but also the gum tissue are stable and fully healed; that the gum level and the “papillae,” the little pink triangular gum tissues adequately fill the space between the implant crown and adjacent teeth. This can indeed result in a very esthetic, functional and long term tooth replacement.

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