Immediate or Delayed? Answer posted....now

Delayed

Rocco Mele DVM

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delayed

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Delayed will be my choice, which will be done after ridge augmentation using either bone block graft "autogenous or allograft block" or by grafting with particulate bone graft+titanium mesh+collagen membrane" and wait for the result for 6-9 months, then implantation can be done. I think this is more safe & more promising for the case.

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Immediate placement; a primary stability with the
Apical part of the implant is Mandotary,bone graft,
CTG from palat.
The bone level of the adjacent teeth will
Determin a good pronostic of the case with one
Intervention.

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Many options; Type 2 defect
Block atog/allograft, DFDBA w some kind of membrane (many choices)to maintain space, BMP 2 etc. This would be my treatment plan for dogs. Close and wait 6/8 months
I would also add PRF to the mix in the particulate allograft or as a membrane before a tension free closure

Rocco Mele

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immediate implant placement is recommended for this case in conjunction with a barrier membrane with layered bone graft approach,only if primary stability of implant is achievable through apical part of the implant/bone interface and engaging the palatal cortical bone.
as if treating facial dehiscence of an implant

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Delayed would be my choice. Specially if you are trying to achieve a stable implant and a perfect soft tissue relationship. An autogenous bone graft with a resorvable membrane and PRGF. After 8 to 9 months of healing, a second procedure could be performed in which the implant could be placed with a CTG. A class II defect with crowns as neighbors would be more secure treated in a delayed approach.

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To make a decisión, it would be preferable a CT scan image; If there is space and the primary stability is possible, the implant should be placed, covered with a bone allograft plus a resorbable membrane and a CTGraft. For the patient It's better to avoid surgeries!

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immedate:with this approach:1-preserved socket 2-esthetic consideration 3-one stage surgery.

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extraction , healing(soft tissue) for 6 weeks.after 6 wks bone grafting (important for primary healing), either block or g.b.r (50% autogenous+bovine) healing for 6 months then implant placement.

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Immediate placement with graft covered by the Korean titanium membrane fixed on the implant with the screw and covered by pericardium membrane

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Immediate with GBR and CTG.This case presents good apical bone for primary stability and adjacent teeth seems to have good bone for papilla preservation. For GBR, I suggest using autogenous bone over implant surface, then Bio-Oss and Bio-gide.

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Immediate if apical stability, angulation can be achieved towards lingual, and Layered bone and CTG can be accomplished by experienced clinician. Less experienced clinician STAGED for sure with BG, membrane and closure.
Sam

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no bone... no implant... graft and reenter to play another day!

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great, very diversified answered. If my patient would go to Atlanta I would let Maurice treat.

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dear dr salama.results is great that means your approch is accurate.i treated some case like your case and results was also good. i think primary stability is a determinant point in these cases.

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Dear Xp Friends;
There is no wrong or right answer. That is why we were split 50% Delayed and 50% Immediate on the responses.
I attempted immediate placement for much of the reasons stated on this board. Type 2 NOT Type 3 Defect environment. Ability to stabilize implant towards palatal wall and apically confined within existing alveolar housing. Ability to perform GBR in closed environment etc. etc.
There is always slightly more risk with this approach then a staged one and we should always condier the patient and situation.
Thanks Dr. Salama

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Dear Maurice: I would have chosen inmediate placement. However, my concerns rely not in primary stability, but in how apical is the implant rough surface in relation to the crestal bone. My doubt is that perhaps, we can achieve less bone resorption if we use an early or delayed protocol, since it is easier to set the implant in its correct position to the bone crest.

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