While it might not be consistent with conventional thinking my preference is to always, when possible, place the fixture at the time of extraction. Attached is a cas of an extraction of a failing #3 with immediate placement of a 5.4 x 10mm ZimVie (formerly Zimmer) TSX fixture. The peri implant void was filled with RegenerOss Plus (ZimVie/Biomet 3i) allograft putty and a 3mm transmucosal healing abutment was placed. I list the materials used only as a disclosure as I am technically in bed with ZimVie and IMHO any combination of products will likely yield the same results. The point of this post is to demonstrate that this can be done in a simple fashion in a single appointment without the use of a lot of materials and techniques…
I love placing immediates as well!!…. In predictable sites that promote favorable long term results.
Not to bash your case here, but in my experience, immediates in the posterior, especially that have a large defect, have a tendency to suffer greatly in 4-5 years. In this case, I extract & graft and just wait three months… just three months…!!!
It could save the patient thousandss of dollars and you the surgeon, a huge headache. It’s three months… waiting that minuscule amount of time can, and will promote better long-term results. I have placed many posterior immediate implants and graft it as you did. I am much more satisfied with the ones that I grafted, waited, and went back in and placed. These are first and second molars I am mainly speaking of. Premolars and anterior’s are a whole different and easier animal typically to place immediately, again in the right situation.
40-50% of the implants I place are immediates… I love immediates, but case selection and educating the patient are paramount. Three months of waiting is nothing when compared the headache of implantitis from posterior bone die back. The patient will appreciate your judgment and patience if you explain to them that three months could save them a lot of time and money.
Just my humble opinion…
I completely understand and can support anyone who chooses to extract and wait a reasonable amount of time prior to placing the fixture. My question is why graft after the extraction and why wait 3 months? What is so special about bone dust that it must be placed in every extraction socket and why wait 3 months after placing the magic dust. If I were to delay the placement I would place 6-8 weeks after the extraction with or without a socket graft. I would not do a socket graft here because I do not find it necessary as it was a completely intact socket and I placed the graft around the fixture only because it made me feel better and I never charge a patient for a graft done at the time of implant placement.
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