I’ve done quite a few posterior implants, and a few anterior implants, but I’m considering placing my first immediate anterior on #7. Pt is healthy middle aged male, who isn’t particularly concerned about esthetics (a lot of old patch-work anterior fillings, low smile line, etc), so I figure it’s a good case to start on. I’m working with the lab on having a guide made, and am considering having them make a temp abutment and temp crown.

My boss claims it’s much better to do an immediate temp to preserve the papilla, but where it’s my first immediate case, honestly, I’d prefer to bury it.

How do you guys determine when to place an immediate temp?? I’ve seen studies showing the papilla in most cases will grow back to fill up the embrasures.

I’m thinking of having the lab just send a custom abutment, and placing the abutment in a month before the impression date for the final crown. What do you all recommend??

https://s3-us-west-2.amazonaws.com/secure.notion-static.com/68841b5e-8fa1-4cb8-9b63-4a8df7f53f87/Screen_Shot_2021-05-05_at_10.05.47_PM.png

https://s3-us-west-2.amazonaws.com/secure.notion-static.com/72ce61b1-ab78-41b6-8094-663fdc2da043/Screen_Shot_2021-05-05_at_10.05.54_PM.png

Ivan:

  1. As far as papilla goes, we just had a great lecture on that topic. It depends on the height of the bone adjacent to the implant. Here is the link to some literature we put together on it:https://www.notion.so/implantninja/Papilla-Height-and-Implants-4f40647862714f33b5466d8cb805db0f

  2. If it is your first immediate case, I would try to do less and do it really well. So rather than try to place, and immediately temporize, I would rather place it and leave it. That way you can really just focus on the surgery.

  3. You can, however, ask the lab to mill a custom healing abutment. That would be awesome! It would help the tissue heal up nicely and it’s super easy for you chairside. When you do get comfortable, i think placing the implant and doing an immediate temp is a great service and helps you start forming the tissue you want right away.

Careful not to sink your implant too deep as you want to make sure to preserve the natural bone level. My very first immediate anterior was also #7, thin biotype,  and I sank that sucker super deep and everything receeded pretty bad.

Jesse:

So there is a fair amount of literature that reports no difference in papilla height between immediate vs delayed placement and between immediate vs delayed temporization. Here a just a couple…

Correlation of Papilla Levels Around Single Tooth Implants in Immediate or Delayed Loading ProtocolsMark R. Ryser, DMD, MD. Michael S. Block, DMD. Donald E. Mercante, PhD

Esthetic Outcome Following Immediate and Early Implant Placement in the Anterior Maxilla – Systematic ReviewStephen Chen, BDS, PhD. Daniel Buser, DMD– Recession of the tooth-implant papilla of 0.5 to 1 mm may be anticipated following implant surgery irrespective of the timing of placement.

So when I got out of residency, after having read papers like these I was like, ok so implant survival is a little higher in delayed placement/loading AND delayed is WAY easier so why ever do immediate!? I starting placing quite a few anterior cosmetic implants and I every time the hard/soft tissue architecture would flatten out and then by the time it was ready to restore Id spend several appointments shaping the tissue with various temporaries. It was such a pain!