Immediate Implants of the Maxillary Incisors

Immediate implantation makes it possible to place an implant in the most ideal position and prevent black triangles.  Immediate implantation is not enough.  Immediate provisional should be provided for the best cosmetic and psychological results.  A flipper not only increases lab fee, but also increases the chance of micromotion of the implant, leading to implant failure.  The most important aspects are to achieve primary stability and make sure that there is no occlusal contact of the involved restoration.

When the primary stability cannot be achieved (either because of implant design, bone quality or iatrogenity), the immediate provisional can be splinted to the neighboring teeth for fixation.

For the lateral incisor, particularly of females, one piece implant is indicated.  For complicated cases, comprehensive treatment including ortho may be required (1).

Cases Planning Surgery F-U Cases Planning Surgery F-U
Immediately Post Trauma Provisional Wire Fixation   Endo-Perio Disease Anatomic Abutment Endogain  
Long Term Post Trauma   1   Vertical Root Fracture Labial Plate Repair Senior Lady, Soft Bone Angled Abut
Why It Fails   1   From Flipper to Implants 1-Piece Implant Apical Buccal Perforation  
Tissue Deficiency, Diabetes 1 2 3   Buccally Displaced Root Good Vision Precise Entry Subcrestal Placement
2 Adjacent Implants in Female 1 2 3 4 5 6 7  Redo #10 Space Issue Small Implant 2.5 mm 1-Piece Implant  
Two Mesiodens 1 2   Severe Deep Bite, Possible Buccal Plate Defect Angled 1-Piece Implant
Comprehensive Treatment  1 2 3 4 5 6 7 8 9 10   #8,9 Atrophic Ridge 2.5 mm 1-Piece WH Possible Buc. Perforation  
Severe Periodontitis Nasal Lift   Wide Lateral Edentulous Space with Diastemata 1-Piece Implant  
Periodontitis, Bruxism 4.5x20 mm Screw Implant   #10 Fractured Crown 1 or 2-Piece Implant Existing Crown  
Smoker, Periodontitis 1 2   #8,9 Post-Related Crown Fracture Existing Crowns  
Difficulty in Non-immediate   1 1 2 3 #8 Severe Atrophy 6 mm Cuff   or Mill Abutment Change to Long Imp Redo
Long Implant   1   #8 Horizontal Root Fracture Longest Implant Hollowed Crown Sticky Bone
Protrusive Centrals 1 2   #7,8,10, Flapless Angled 1-Piece Flap for #7,8  
Incisive Canal 1 2 #9 Crown/Post Fracture Non-Gold Coated 4 mm Abutment  
Low Torque: Senior Immediate No Buccal Plate   9 Exfoliation; Exostosis   Incisive Canal  
Trajectory Small Implants Abutment Diameter #8 Redo #10 Thin Buccal Plate and Thin Bone Narrow Mesiodistal Space  
Labial Plate Defect   Tuberosity   7-10 Chronic Periodontitis Large Incisive Canal 2.5 mm 1-Piece Implants  
Bone Graft 1st or not   1   9 Exfoliating Implant Supports Bone Graft Prevent Buccal Plate Collapse  
Why Not Immediate   Infection Source   9 Root Tip Resorption Temporary Abutment PRF and Allograft for Repair  Ortho
Atrophic Crest at Lateral 1 Piece/Onlay Graft 2.5 mm 1 Piece   8 Subgingival Frature Several Missing Back Teeth Trajectory Check  
Severe Bone Loss Which 1st: Graft or Implant   9 Large Periradicular Radiolucency Nasal Floor/Incisive Foramen 3.8x15 mm Close to Nasal Floor  
Loss of Labial Plate Where to Graft? How to Close Fistula   10,12 Narrow Ridge Guide for 1-Piece Implants?    
Hardship of Delayed .. Oblique Trajectory     8/9 Cantilever FPD Narrow Dense Bone Right on the Target  
Labioincisal Shift, Occlusal Trauma Easier, Re-treatable Periimplant 2 Redo Design   7 Residual Roots, 87 y/o Lady 2.5 mm 1 Piece; Socket Shield Palatal Osteotomy  
Malposition with Delayed .. Design What is wrong?   10 Fractures against Implant-supported Temporary Emergency Immediate  
Limited Vertical Height Deep Placement Adjust Position Periimplant 2 8,9 Buccal Plate Loss Free Hand Immediate PRF/Sticky Bone for Soft/Hard Defects Bone Graft
Narrow Ridge at Lateral   Approaches   9 Equigingial Fracture Bruxism Palatal Osteotomy  
Labial, Incisal Drifting Abutments Buccal Gap Closure 7 Fracture Related to Class V Defect Repair Apical Buccal Defect
Early Implants Expansion Initially Placed as Immediate   9,10 Residual Roots Cantilever FPD Depth 1st  
Deviation of Root   How to Correct it?   10 Labial Concavity 2.5 mm 1-Piece Implant External Fixation  
Bruxism Limited Vertical Ht Osteotomy Adjust.   7 Equigingival Fracture Lower RPD Aborted Shield  
Central Fractures Equigingival Epinephrine          
Female Senior, Osteoporosis Under Prep 9,31 Prevent Periimplantitis 9 Crown instead of Implant    
Male with Brain Tumor Surgery Osteoporosis   9 Post Fracture, Bruxer      
From FPD to Single Units Metronidazole Study Rebuild Buccal Plate   #10 Residual Root Socket Shield    
Atrophic Buccal Plate of #9 Palatal Placement Edge to Edge Normal Bite Tooth Fracture Post RCT 2-Step Grafting    
Atrophic Crests: #7-10 1 Piece Implants Heal   Atrophic Lateral Site Angled 1-Piece Implant    
Long Root Low Density Bone Long Implant 1-Piece Delayed   9 Crown Fracture Bruxism, Deep Bite    
Post-Ext Buccal Plate Collapse D implant   9 Heavy Occlusion Deep Bite    
RPD Anchor Tooth Fracture Senior Osteoporosis Long Implant   #7 Perio Abscess Post Lower Quadrant SRP    
Central Root Fracture Preop PA Cemento-Enamel Junction   9 Unilateral Mastication Bruxer
Chronic Periodontitis Acute Episode,  Immediate Placement RPD 9 10 Buccal Placement Redo with Guide    
Long Term Trauma to #8,9 Narrow Implants Temporary Abutments   10 1-piece implant with 1.5 mm Bone on Either Side
Central Root Fracture Preop PA Cemento-Enamel Junction 7-9 Fractured FPD Angled Abutments Socket Shield  
Subgingival Fracture Senior Lady Underprep, UF Early Regraft #8-13 One piece Implants #8 Implant Fractures  
Failed Bridge Pre-mounted Implants Control Implant Depth 10 Thin Bone Onlay Graft    
Periodontally Displaced Central Place Implant Deep Clearance from Partial   8-9 Loose Splinted Crowns      
Post-Induced Root Fracture Premature Contact Small, Long Implant PRF   10 Narrow Native Bone Not So Narrow As CT Shows  
Extruded Lateral Repair Buccal Plate Repair Defect Before Implant   6  Large Gingival Embrasure Temporary Abutment    
Possible Palatal Plate Defect PRF Buccal & Palatal Defects Redo        
Fractured Fiber Post & Crown Hollow Crown Straight Abutment Emax?        
Extruded Central Incisor Labial Plate Defect Labial Margin   8 Apico 9 Immediate      

Immediate Implant

Xin Wei, DDS, PhD, MS 1st edition 02/09/2014, last revision 01/19/2020