Why do we have to wait a while to place the final crown after placing an immediate implant?

In today's blog entry I would like to address a topic that is very recurrent in the office and to which I have to respond frequently in my clinical practice, as there are many patients who, after an extraction with immediate implant, expect to recover their full aesthetics and functionality as soon as they walk out of the clinic door, and when I explain to them that they will have to wait at least three months for the placement of the definitive crown, the question is always the same:

Why do we have to wait a while to place the final crown after placing an immediate implant?

In fact, in order to answer this question adequately, it is essential to understand the two general phases of implant-based rehabilitation treatment:

The first phase

The first phase would be the implant placement phase, which is colloquially known as the 'screw'. We perform the surgery, place the implant and a healing cap over it to maintain the gum.

This healing, or healing process, is the one that will last between 3 and 4 months, when osseointegration will take place, that is to say, the definitive union between the implant and the bone.

The second phase

After this phase of 3 to 4 months of healing, in the clinic we check the stability of the implant using a special device that gives us a value between 1 and 100, known as the ISQ value. If the stability (implant-bone union) is correct, then it is time to place the definitive crown.

And this is when it comes to...okay, but, Why wait so long?

The crown is the piece that will transmit the chewing forces to the implant and it is therefore essential that the implant is cured before it is made, to ensure that it can withstand this transmission of forces correctly without increasing the chances of implant failure, with the discomfort for the patient and their dental health that this would entail.

These biological principles are basic and must also be complied with when we place immediate implants and sometimes the healing times are longer than those of other types of implants, because due to the clinical situation, we do not achieve the ideal stability (strength of the bond between the implant and the bone).

However, whenever possible, we try to place the implant immediately after an extraction, as this is the only way to ensure that the implant is placed immediately after the extraction:

  • We prevent further bone loss.
  • We shorten the patient's treatment time by avoiding having to perform more surgeries, as we place the implant on the same day as the extraction.
  • We maintain as far as possible the soft tissues surrounding that part.

And while the final crown is being fitted?

Many patients, especially when the implant is in the esthetic sector (e.g. an upper central incisor or a canine), are concerned about having to go 'nicked' after the implant. However, in these cases, there is the option of placing the implant and making a temporary crown attached to that implant while we wait for the implant to heal.

In this way, we respect the 3-4 months of healing and we can also maintain the aesthetics during this period and then replace the temporary crown with a definitive one.

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