Post-extractive implants: Clinical indications and literature analysis

OBJECTIVES: The aim of this study is to evalua-te the current state of the art in the management of the patient with the need for implant placement immediately after the extraction of the dental element. The advantages and disadvantages of the different therapeutic options in the fixed implant rehabilitation of the post-extractive socket have been analyzed. Authors’ clinical experience will be taken also into consideration to better support scientific evidence. MATERIALS AND METHODS: Taken into consideration the recent literature and scientific evidence, the current studies with the highest scientific impact have been exami-ned. In particular, the different im-plant insertion timings, contextual to the extraction of the dental ele-ment (immediate), after 6-8 weeks (immediate-delayed) and the clas-sic approach after 4-6 months (de-layed) were evaluated. The management of the bone to implant gap and the need to sur-gically preserve the post-extrac-tion site have been also analyzed. RESULTS: No statistically significant differences emerged between the various implant placement timings, in terms of failures, complications and patient satisfaction. However there seems to be a tendency for failure and complications in immediate and immedia-te-delayed implant placement, which are also technically more demanding. On the other hand, patients whom rehabilitation times are considera-bly reduced tend to be more sati-sfied. Moreover, immediate implant placement does not seem to prevent considerable loss of bone volume, while the use of bone grafts in the bone to implant gap seems to decrease the physiologi-cal buccal bone resorption, even if there are no statistically signifi-cant differences in the studies ta-ken into consideration. Additionally, the alveolar ridge preservation, compared to extraction alone, reduces the need for a surgical session in order to recon-struct the bone. No particular differences emerged by comparing various types of bio-materials or membranes, however, the application of biomaterial in as-sociation with resorbable membranes seems to achieve good results in terms of loss of bone volumes. CONCLUSIONS: According to the current literature and the authors’ experience, post-extractive implants are nowadays considered as an alternative to tra-ditional procedures because they can have important benefits for both the patient and the clinician. However, there are a tendency for more failures and complications associated with this procedure. If the clinician decides to place post-extractive implants or delay-ed implants, in either cases, our suggestion is to fill the bone to im-plant gap with biomaterial in as-sociation with a resorbable mem-brane in order to prevent loss of bone volumes. However, larger studies, especial-ly Randomised Controlled Clinical Trials (RCTs) with longer follow-ups are needed to better evaluate these alternatives. CLINICAL SIGNIFICANCE: Post-extractive implant placement can be an option for those patients requiring a reduction in re-habilitative times. However, the potential disadvantages, such as failures and complications should be always clarified and discussed with the patient along with possible therapeutic alternatives.