Online Referral Form

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Technical Note:

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Newsletter Articles

Case Study 5 Immediate Implants, Part 2 (In the presence of infection)

Immediate implants in the presence of infection (from periodontal disease or periapical disease) have not traditionally been performed routinely. The reason for this is increased implant failure rate and an increase in the incidence of post-operative infections. The presence of anaerobic bacteria in the deeper pockets has been well documented and is implicated in implant failure. However, if you can attain rigid fixation with the implant, all fibrous or epithelial tissue is completely removed from the extraction socket, and appropriate antibiotics are used, success can easily be achieved. Proper case selection is very important. Adequate bone is the prerequisite. Even if small fenestrations or dehiscenses exist, stability can be achieved. A bone graft is usually added and more often a guided bone regeneration membrane as well. Tight closure of the soft tissue around the implants is needed, not primary closure. With one-stage implants (such as ITI) primary closure is not achieved anyway.

The case shown involves a 75 year old female referred to our clinic for implant evaluation. The existing bridge fell out and the remaining tooth structure was inadequate to fabricate a new one. An option would have been to fabricate a 5-unit FPD, but long-term success would easily favor implant placement. Tooth #4 was fractured and abscessed. Tooth #6 was fractured and unrestorable. A flap was reflected and the teeth were extracted, sockets debrided, and osteotomies prepared in the existing sockets. Adequate bone was available to obtain rigid fixation of the implants. No guided bone regeneration membrane was needed in this case, due to the implants adequately filling up the coronal portion of the sockets. The healing was uneventful and abutments were placed 3 months later. The case is presently in temporaries while the final FPD is being fabricated.