Guidelines for Immediate Peri-implant Gap Management
by Dale R. Rosenbach, DMD, MS
1) When treatment planned for extraction (and potential immediate implant therapy), teeth should be extracted in the most atraumatic manner possible. Forces should be applied with low velocity and high duration to minimize trauma to the adjacent hard tissues, and the sectioning of multi-rooted teeth ought to be employed to prevent damage to facial plates and furcal bone, especially for molars.
2 ) Unless deemed absolutely necessary, such as when ridge augmentation is being employed simultaneously with implant placement, flaps should be avoided,1 and especially in the anterior where the facial bone is often less than 1mm thick.
3 ) Implants should not be intentionally malpositioned or misangulated in close proximity to the facial plate in order to decrease the effective horizontal dimension of the peri-implant gap.
1 Rather, the position and angulation of the fixture should be chosen primarily by determinants such as the need to achieve adequate primary stability and to be in line with an appropriately recognized restoratively driven plan.4 ) Following implant placement, peri-implant gaps into which graft may be freely introduced (greater than 1mm in dimension) should be grafted to prevent ridge width deficiency and promote greater bone-to-implant contact.
5 ) Even if less than 2 mm, peri-implant gaps ought to be grafted because, to me, the potential benefits of doing so vastly outweigh the potential risks of not doing so.
6 ) Practically speaking, particulate bone graft cannot easily fit into gaps less than 1mm in dimension, and so these gaps
need not be grafted. If considerable undercuts exist under the coronal extent of the facial plate of bone, graft material may be introduced prior to implant placement, especially in the anterior.7) If no flap is being advanced over the gap, grafted or not, use of a barrier membrane is not necessary. Resorbable collagen tape or plugs or sponge may be used for graft containment and sutured into place, if necessary,
2 6 and if a healing abutment is placed or the implant is immediately temporized in such a way as to prevent disruption of the particulate graft material, even this may not be needed.http://www.dentaltown.com/Dentaltown/OnlineCE.aspx?action=DETAILS&cid=498
Xin Wei, DDS, PhD, MS 1st edition 11/09/2014, last revision 11/12/2014