????

[AmyLouRDH]

Does anyone know anything about having a tooth extracted and an implant placed at the same time? I thought the bone had to heal first?

[Craig]

Amy,

That's a good question, and one that I asked several dentists in the past. The general thought is that it IS possible to place an implant at the time of the extraction, but the amount of bone that is left after the extraction has to be sufficient, and the type of implant used has to enhance bone growth. I'm not sure what the success ratio is on that procedure, but I do know its done, just not frequently.

Craig

[AmyLouRDH]

So do lab technicians like making crowns for implants? (BTW my goal this wkend is to beat your pacman score.) Thanks for replying. I want my sister to get an implant instead of a bridge and I get nervous suggesting something to a family member that I have not heard a lot about. I went to a 9hr CE class on implants and they never talked about that, of course they may have when I was "resting my eyes."

[Craig]

Do we "like" making crowns for implants??? Hmmm... Yeah, I guess so. There are a few extra steps in some of the process, and there are different options, depending on the type of implant the surgeon or dentist uses, but all and all, I'd say, they're just as much fun to make as a normal crown.

As for your sister, I'd strongly suggest an implant before a bridge. But be sure to let her know that not EVERYONE is a good candidate for an implant. The proper bone structure MUST be there. If it was one of my sisters, I'd have them get a CT done, and have that reviewed by the surgeon and or lab. With the CT, they can tell whether the bone is thick and strong enough, and where to place the implant. If it's a go, and she opts for it, then they can actually design a surgical stint for the implant, using the CT scan. I'll try to post a screen shot or two here, so you can see how much information the scan gives the surgeon.

BTW... Good luck on the PacMan score. :P

[Dr Steve Schwartz]

Hey, Guys (and girls)! I hope this helps:
It has become very common now to place an implant at the time of extraction. Typically the site might need some bone grafting in addition, but this helps preserve bone. When we extract teeth, the bone no longer has the support of the tooth and resorbs (shrinks). This provides less support for the implant. So, it often makes more sense to place the implant immediately. However, infection and other factors can limit the ability to do this.

[Dr Steve Schwartz]

RE: IMPLANT INSTEAD OF BRIDGE
If the teeth acting as abutments need crowns, then bridges make sense. However, too many patients are missing teeth but have virgin or near-virgin teeth on either side of the space. Then I consider it destructive to crown them. I would still rather see teeth kept seperate; i.e. not joined together. Patients can floss better, and any issue that involves one tooth only involves one tooth. That is, one tooth of a 3 unit bridge now involves 3 teeth. All things considered, I would rather restore max laterals w/ implants than endo-post-and-core-and-crowns, as they fail (read: break) so often.

[TheLabGuy]

Many insurance agencies would rather have you prep the adjacent teeth to make that a three unit bridge though (never could understand that). Now I'm curious though, if doing a immediate implant after extraction is their a particular implant abutment that is preferred i.e. UCLA, screw-retained, etc.? and do you use a different healing cap considering the resorption of the tissue during healing?

[Dr Steve Schwartz]

Re: immediate placement...
I don't think there is any one implant considered "best" for this. What I have seen/discussed with surgeons placing these is the use of bone graft material to fill in any remaining hole/defect and the use of closure with membranes during the healing phase. To the best of my knowledge, this is what prevents resorption during healing.