Immediate Implantology and Immediate Restoration

  With the widespread use of dental implants in clinical practice, their aesthetic, comfortable, no-grinding, and good chewing function restoration features are gradually recognized and accepted by people, and more and more patients choose to use dental implants to restore their missing teeth. The classical oral implant technique requires a healing period of 3-6 months after tooth extraction before implant placement, and then 3-6 months after implant placement to achieve osseointegration before crown restoration. Thus, the patient has to endure the inconvenience and distress of being without teeth for a longer period of time. Recent developments in oral implant technology have made it possible to place implants immediately after tooth extraction and to restore crowns at the same time or at an early stage. The application of immediate implant and immediate restoration technology allows the extraction, implant placement and temporary crown restoration to be completed in a relatively short time or even in a day. A large amount of clinical data shows that, with proper indications, immediate implant placement does not differ significantly from traditional implant techniques in terms of success rate and is better than traditional implant restorations in terms of aesthetic results.  The advantages of immediate implant placement are as follows: 1. shortening the treatment and waiting time for missing teeth; 2. reducing the number of surgeries and surgical trauma; 3. making the positioning of the implant more biomechanical and achieving the ideal anatomical position; 4. preventing the resorption and atrophy of the alveolar bone due to tooth extraction and effectively maintaining the alveolar bone. 4. to prevent the resorption and atrophy of the alveolar bone due to tooth extraction, and to effectively maintain the height and width of the alveolar bone; 5. to have a good aesthetic effect on the soft tissue.  The indications for immediate implantation are: 1) severe crown loss to the subgingival level, which cannot be restored conventionally; 2) root fracture; 3) teeth with failed root canal treatment; 4) teeth with severe periodontal disease.  However, if the affected tooth is infected at the root tip, if the periodontal soft and hard tissue inflammation is in the acute active stage, or if the periodontal bone is so severely damaged that the ideal initial stability cannot be obtained, the success rate of the procedure will be affected and immediate implantation is generally not recommended.  Immediate restoration is the opposite of postponed restoration, which means that the abutment is installed immediately after the implant is placed in the jawbone, and the upper denture is restored immediately, keeping the missing teeth intact throughout the restoration process, reducing the number of follow-up visits, maintaining the morphology of the teeth, gums and alveolar bone, and achieving good aesthetic results. The immediate restoration technique is a challenge to the traditional implant theory, which requires a load-free healing period of 3 to 6 months after implant placement, considered as one of the necessary conditions for successful implant placement. However, more and more experimental and clinical results prove that proper functional stimulation after implant placement facilitates bone growth and remodeling. Implants with good initial stability can withstand a certain amount of occlusal force, and moderate occlusal forces transmitted through the implant to the alveolar bone can produce physiological stimulation, which will facilitate the formation of osseointegration in the area of stress concentration, where bone trabeculae are rationally aligned in the direction of occlusal forces. The immediate loading theory study concluded that implant osseointegration in immediate restorations depends mainly on the initial stability of the implant after implant placement. Implant failure is due to poor initial implant stability and excessive “micro-movement” of the implant-bone interface during the bone healing period, not due to early loading.  At present, immediate implant and immediate restoration techniques have been successfully applied in clinical practice, providing a better option for restoring the affected teeth in patients with missing teeth.