Immediate Dental Implant Placement in Sockets Augmented With HTR Synthetic Bone

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Immediate Dental Implant Placement in Sockets Augmented With HTR Synthetic Bone
March 2004
Castellon, Paulino DDS*; Yukna, Raymond A. DMD, MSǃÜ
Implant Dentistry: Volume 13(1) March 2004 pp 42-48
Lippincott Williams & Wilkins
*Assistant Professor, Department of Prosthodontics, Louisiana State University School, New Orleans, Louisiana.
ǃÜProfessor, Department of Periodontics, Louisiana State University School, New Orleans, Louisiana.
Reprint requests and correspondence to:
Paulino Castellon, DDS
Louisiana State University School of Dentistry
Department of Prosthodontics
Box 222
1100 Florida Avenue
New Orleans, LA 70119
Phone: (504) 670-2778
Fax: (504) 619-8741
E-mail: pcaste@lsuhsc.edu
Abstract
Purpose: The purpose of this article is to present the results of using immediate implant placement in combination with HTR synthetic bone socket grafting to achieve a predictable restorative result.
Material and Methods: Twenty-three hydroxylapatite-coated cylinder implants (SplineǗ˘, CenterPulse Dental, Carlsbad, CA) were placed into fresh extraction sockets in 19 patients. In each case, HTR synthetic bone (Bioplant, Inc., South Norwalk, CT) was used to fill any voids remaining in the sockets and to augment the facial aspect of the ridge. The restorative phase was initiated approximately 6 months after implant placement. Conventional impression techniques were used and porcelain-fused-to-metal crowns were selected as the final restorations.
Results: The prosthetic outcome was evaluated as generally favorable. Only 4 (17%) of the dental implants required an angled abutment. The gingival contour was excellent in 61% and good in 35% of the cases. The emergence profile was evaluated as class I (full papilla) in 37% and class II, III, and IV in 21% each.
Conclusions: The clinical results of this study demonstrate that immediate implant placement in combination with HTR synthetic bone grafting of residual socket voids and crestal deformities is a predictable procedure and provides a good base for successful prosthetic reconstruction. Adequate gingival contour and favorable emergence profile can be expected when combining immediate implant placement and HTR grafting material.
The use of dental implants has become an increasingly common and successful modality in restorative dentistry. Immediate implant placement is the process in which a dental implant is placed directly into an extraction socket site after tooth removal. As a result of the decrease in treatment time compared with the traditional 2-stage protocol, and sometimes cost, the use of the immediate technique has grown in recent years.
The natural pattern of resorption of the alveolar ridge after tooth extraction would result in a deficient ridge that could be problematic for future implant placement. It has been shown that 40% to 60% of the remaining alveolar ridge could be lost after tooth extraction in the first few months or years. 1-3 If the ongoing resorptive process is not addressed at the appropriate time, the prosthetic replacement of the hard and soft tissues would be more difficult, the aesthetic result will be compromised, and the prognosis of the final restoration diminished. Furthermore, concomitant changes in the soft tissue will compromise the prosthetic, functional, and esthetic result of the final restoration.
It has been historically recommended that a period of 6 to 12 months be allowed for complete healing of the extraction site before implant placement. 4,5 According to Barzilay, 6 osteogenic and osteoresorptive responses are already initiated after extraction and the tissue could have an enhanced capacity for healing. Gelb 7 stated that the resorptive and remodeling process of the crestal bone after tooth removal could result in an apical and lingual loss of ridge anatomy, which could be detrimental for the positioning and angulation of an implant and consequently to the longevity of the prosthetic restoration.
To fulfill both functional and esthetic requirements, it might be necessary to plan implant placement in concert with the extraction of the tooth and socket grafting/ridge preservation techniques. There is evidence that the alveolar ridge resorption can be attenuated or prevented by the use of some regenerative techniques used at the time of tooth extraction, 8-10,30,31,42 and by the immediate placement of implants. 25,33
Salama 11 classified the extraction site into 3 types and with 2 zones, describing the procedures recommended for each. Information from this article is summarized in Table 1.
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