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   Atrophic Crests: #7-10 1 Piece Implants Heal  
Long Term Post Trauma   1   Long Root Low Density Bone Long Implant 1-Piece Delayed
Why It Fails   1   Post-Ext Buccal Plate Collapse D implant  
Tissue Deficiency, Diabetes 1 2 3   RPD Anchor Tooth Fracture Senior Osteoporosis Long Implant  
2 Adjacent Implants in Female 1 2 3 4 5  6 7 Central Root Fracture Preop PA Cemento-Enamel Junction  
Two Mesiodens 1 2   Chronic Periodontitis Acute Episode,  Immediate Placement RPD
Comprehensive Treatment  1 2 3 4 5 6 7 8 9 10   Long Term Trauma to #8,9 Narrow Implants Temporary Abutments  
Severe Periodontitis; Nasal Lift 1   Central Root Fracture Preop PA Cemento-Enamel Junction  
Smoker, Periodontitis 1 2   Subgingival Fracture Senior Lady Underprep, UF Early Regraft
Difficulty in Non-immediate   1 1 2 3 Failed Bridge Pre-mounted Implants Control Implant Depth  
Long Implant   1   Periodontally Displaced Central Place Implant Deep Clearance from Partial  
Protrusive Centrals 1 2   Post-Induced Root Fracture Premature Contact Small, Long Implant PRF  
Incisive Canal 1 2 Extruded Lateral Repair Buccal Plate Repair Defect Before Implant  
Low Torque: Senior   1   Possible Palatal Plate Defect PRF Buccal & Palatal Defects Redo
Trajectory Small Implants Abutment Diameter   Fractured Fiber Post & Crown Hollow Crown Straight Abutment Emax?
Labial Plate Defect   Tuberosity   Extruded Central Incisor Labial Plate Defect Labial Margin  
Bone Graft 1st or not   1   Endo-Perio Disease Anatomic Abutment Endogain  
Why Not Immediate   Infection Source   Vertical Root Fracture Labial Plate Repair Senior Lady, Soft Bone Angled Abut
Atrophic Crest at Lateral 1 Piece/Onlay Graft 2.5 mm 1 Piece   From Flipper to Implants 1-Piece Implant Apical Buccal Perforation  
Severe Bone Loss Which 1st: Graft or Implant   Buccally Displaced Root Good Vision Precise Entry Subcrestal Placement
Loss of Labial Plate Where to Graft? How to Close Fistula   #10 Space Issue Small Implant 2.5 mm 1-Piece Implant  
Hardship of Delayed .. Oblique Trajectory     Severe Deep Bite, Possible Buccal Plate Defect Angled 1-Piece Implant
Labioincisal Shift Occlusal Trauma Easier, Re-treatable Periimplant 2 #8,9 Atrophic Ridge 2.5 mm 1-Piece WH Possible Buc. Perforation  
Malposition with Delayed .. Design What is wrong?   Wide Lateral Edentulous Space with Diastemata 1-Piece Implant  
Limited Vertical Height Deep Placement Adjust Position Periimplant 2 #10 Fractured Crown 1 or 2-Piece Implant Existing Crown  
Narrow Ridge at Lateral   Approaches   #8,9 Post-Related Crown Fracture Existing Crowns  
Labial, Incisal Drifting Abutments Buccal Gap Closure #6 Severe Atrophy 6 mm Cuff   or Mill Abutment Change to Large Imp  
Early Implants Expansion Initially Placed as Immediate   #8 Horizontal Root Fracture Longest Implant Hollowed Crown  
Deviation of Root   How to Correct it?   #7,8,10, Flapless Angled 1-Piece Flap for #7,8  
Bruxism Limited Vertical Ht Osteotomy Adjust.   #9 Crown/Post Fracture Non-Gold Coated 4 mm Abutment  
Central Fractures Equigingival Epinephrine   #8 4mm Abutment      
Female Senior, Osteoporosis Under Prep            
Male with Brain Tumor Surgery Osteoporosis   #10 Residual Root Socket Shield    
From FPD to Single Units Metronidazole Study Rebuild Buccal Plate   #7 Perio Abscess Post Lower Quadrant SRP    
Atrophic Buccal Plate of #9 Palatal Placement Edge to Edge Normal Bite Tooth Fracture Post RCT 2-Step Grafting    
        Atrophic Lateral Site Angled 1-Piece Implant    

Immediate Implant

Xin Wei, DDS, PhD, MS 1st edition 02/09/2014, last revision 11/05/2017