Clinical protocol for a high insertion torque immediate implant in fresh extraction sites: A 3-year audit

Purpose: The purpose of this report was to evaluate the clinical protocol of a variable-thread tapered implants placed by high insertion torque in fresh extraction sites either loaded immediately or in stages in a 3-year period.The deciding parameters including insertion torque, implant dimension, extraction socket status, jumping gap grafting decision, time to definitive restoration loading and the cumulative survival rate were analytically evaluated.Materials & methods: 45 implants were placed in 34 patients in a private oral maxillofacial surgery specialist practice according to a standard protocol.All teeth were removed a traumatically then immediate implant placement into the fresh extraction socket that either restored provisionally or in staged protocol.For those immediate temporized and function implants were installed via flapless approach except at molar region.Peri-implant gap to extraction socket wall >1.5mm were grafted.Definitive restorations all were placed within the first year.Regular Clinical and radiographic assessment were performed after implant placement at 6 months, 12 months and 24 months.Results: Thirty-four patients were treated and were restored with 41 single crowns and 2 two-unit bridges.Amongst 45 implants, 27 were immediately temporary restored and function were all survive.Contrary, two one-staged immediate implants were failed need redo prior to 3 months.Therefore the overall cumulative survival rate in this cohort became 95.6%.Male to Female ratio = 16:18 with the mean age was 50.6 ± 13.5 (range 17-76).The distribution of implant placement found mainly in maxilla 84.4% (38 implants).Ten teeth (22.2%) presented with peri-apical abscess prior to surgery that submitted to immediate implant surgery without any case of failure in this series.High insertion torque >50-70Ncm could be achieved in 73.3% (33/45) of implants as its initial stability with medium bone quality as majority (84.4%).64% peri-implant gap>1.5mmwere grafted so as to maintain an optimal peri-implant bone healing.Regarding implant dimension, almost 31.1% were RP 5mmx13mm (14 out of 45) being selected most commonly for immediate implant placement.The mean timing for final prosthetic loading were 3.4± 1.2 months (range 3 weeks to 8 months) Conclusion: The 3-Year results show that immediate placement of a variable-thread tapered implants by high insertion torque (>50 -70Ncm) in fresh extraction socket could achieve a high survival rate at 95.6% ,moreover immediate temporary restored and function group even achieve 100% cumulative survival in this cohort.Several pivotal parameters were concluded as a clinical protocol for immediate post-extraction implant rehabilitation.