Implant dentistry has advanced tremendously since the early days of our pioneers that include Drs Linkow, Tatum, Branemark, and many others. Without them we would not have reached the degree of clinical success that we now enjoy. Through careful fact finding, treatment planning, and precise execution, patients and implant dentists can achieve their intended results. Original protocols called for the 2-stage implant placement approach with a 4–6 month submerged, undisturbed healing period, followed by exposure and progressive loading, with eventual placement of the definitive restoration. Oftentimes this procedure took 12 to 18 months. This has been proven to be a very predictable methodology with a timeline that us old-timers have grown comfortable with. However, patients want the desired results sooner.
Thanks to research that has resulted in better implant body, thread, and coating designs clinicians can now achieve the desired results for patients in a much shorter time-period. These advances have allowed for immediate or early placement following tooth extraction. Still, every method employed in Implant Dentistry has advantages and disadvantages. There are situations that require the 2-stage technique because of the bone morphology, nature of the case, and the patient’s physiology. However, there are circumstances that permit the immediate or early placement of the implant(s). The experienced, well educated Implant Dentist acquires judgment that considers the risk of implant success or failure, as well as the unpredictable future hard and soft tissue morphology. The experienced clinician will also consider the patient’s medical history and be aware of absolute or relative contraindications that may affect immediate or early placement.
This is not an Editorial against immediate or early placement. This is an excellent modality for the patient with the correct local hard/soft tissue conditions and a medical history that does not contraindicate this treatment. The use of this modality has multiple benefits and some risks. As clinicians, we owe it to our patients and the profession to make reasonably well informed recommendations that will lead to successful implant placement and restoration. Patients and their families are depending on each of us to use our best judgment and not let the lure of “good press” about getting teeth immediately to fog our decision making. I also encourage clinicians to be certain that they have acquired the skill, experience, and knowledge necessary to provide this advanced form of treatment. Knowing your “comfort zone” in Implant Dentistry and being personally honest with yourself will help you make the correct recommendation.
James L. Rutkowski, DMD, PhD
Journal of Oral Implantology