Immediate Implants- Teeth in the Day
Saturday, June 27th, 2020, 2:30:00 PM
Ask Dr Gerald Tan about:
Some questions you can ask are:
- Should You Consider Immediate Tooth Replacement?
- What's The Difference Between Immediate And Delayed Dental Implant Placement?
- Should I get an immediately after a trauma-related injury?
Dr Gerald Tan was voted by his peers to be the youngest and longest-serving president of the Aesthetic Dentistry Society of Singapore (ADSS) from 2012-2016. ADSS also selected him to be on the Singapore Dental Association’s Ethics Committee in 2014. His past experience as a commissioned Dental Officer at the Singapore Armed Forces, National Dental Centre Singapore, SingHealth Polyclinics, and the School Dental Centre, Health Promotion Board enriched him with necessary skills to start his own private group practice in 2013 by the name of Elite Dental Group, with a vision to eliminate severe dental anxiety often associated with complex dental treatment.
Don't smoke, not even a single stick. Secondly, keep meticulous oral hygiene. But having said that, don't over brush the area because if you overbrush the surgical site, it can destroy or disturb the wound. When you have a wound, you want to be very gentle when brushing around the area of the surgery but still you need to brush to keep good oral hygiene. Thirdly, take all of your medication religiously: all the antibiotics, antiseptic mouth rinse, sometimes even prescribed probiotics. All these will help and aid healing. Lastly, please do not bite the implant.
In my hands, from doing so many implants and dental surgeries in my life, I will say the most common reason for osseointegration failure is smoking. I repeat, in my experience, smoking is the most common and important reason for osseointegration failure. After the implant is placed, the patient is normally very happy without much pain or swelling. They think they are out of the woods and they start smoking again.
Well, if there is osseointegration failure, typically how it presents itself is that the implant is loose, no longer firm in the gum or bone. Otherwise, the implant is wobbly and it happens sometimes due to an infection. So we always look out for swelling, pus, or abscess, anything that could indicate an infection in that area. If the surgical site is infected and osseointegration occurs then I'm afraid the immediate implant has to be removed and we have to start all over again. We remove the immediate implant, maybe put a bone graft in, and then we transfer the case to a delayed implant.
Getting immediate implants sometimes is more costly because it involves computer-guided surgical planning. It involves more procedures done in one visit, more bone grafting, and immediate implants. So it's those few implants on that build. If you are going to get sedated that's an extra item on the bill because the anaesthetist will have to come into sedate the patient for the surgery. There are basically more items on the bills and the immediate implants are more costly compared to delayed implants. But for the delayed surgery, it may still be the same.
That would be a straightforward way of removing all the damaged teeth that are hopeless. If a bone graft needs to be done, we will do the bone graft, if the gum graft needs to be done, we will do the gum graft, and then we will suture and close up the surgery there and the patient will not be getting an implant. The patient will be getting some kind of a denture so that at least when they smile they have teeth.
That's a good question. We can actually do implants in an emergency situation, but we also do immediate implants in a non-emergency situation. The advantage of non-emergencies is that there is time to slowly plan and make the temporary crowns in the lab. But in the real emergency scenario where there is no time for the lab to fabricate the crowns then the dentist will have to fabricate the temporary crowns in the clinic on the day of surgery.
Yes, it's a similar kind of recovery process. I wouldn't say that it is vastly different. With an immediate implant or conventional delayed implant, typically the immediate recovery from the surgery can be 1 to 2 weeks. Then we wait a typical 3-6 months or sometimes 8 months for the bone to fully regenerate. So, it's not too different.
No, if the surgery is planned out properly and major structures are avoided like major nerve branches are avoided then there should not be any issues whatsoever. Again, treatment planning is crucial. For me when a case is dicey, computer-guided planning is critical so that the level of accuracy and predictability increases in such a case, so I know nothing can go wrong. I know that there will be no injury to the nerve or numbness, this kind of things.
The duration of the surgical procedure really depends on the number of implants being placed. If one implant is placed, removing one tooth, a typical procedure like that could be an hour long. But if you have 2 or 3 immediate implants, that could take up to 2 to 3 hours, sometimes even 4 hours. Sometimes, when we put immediate implants, we also do simultaneous procedures like a bone graft. Sometimes we do immediate implants with a simultaneous gum graft. So we can do a few simultaneous procedures with the implant which could lengthen the duration of the procedure.
The risk for immediate implants is higher than for one placed in a delayed fashion. The risk is, of course, delayed osseointegration of the immediate implant. Osseointegration is a concept where the implants and the bone fuse together and this concept of Osseointegration is relevant not only for dental implants but also for hip implants or any kind of implants placed in the body. I'm sure you have heard of people going for surgery for knee or hip replacements with metal implants.