Dental implant therapy increasingly emphasises shortening
treatment time and minimising surgical morbidity while maintaining long-term
biological stability and esthetic integration. Two approaches that aim to
reduce or avoid extensive hard-tissue surgery are (i) implant placement through
impacted teeth or retained dental tissues (hereafter, “transdental” placement)
and (ii) immediate post-extraction implant placement in fresh sockets. Implant
placement through impacted teeth generally describes preparing an osteotomy
that passes through the enamel and/or dentin of an impacted tooth that remains
in situ, followed by insertion of an implant along that trajectory. On the
other hand, immediate implant placement refers to inserting an implant into a
fresh extraction socket during the same surgical session as tooth removal.
Although both strategies may reduce the number of surgical stages compared with
conventional delayed placement, they arise from different clinical problems:
transdental placement is typically considered when an impacted tooth obstructs
the ideal implant trajectory and surgical removal would create substantial
defects, whereas immediate placement addresses replacement of a failing or
hopeless tooth at the time of extraction.
This narrative review synthesises contemporary evidence on
survival, marginal bone loss, and complications for each approach, and
interprets these outcomes through a biological and risk-management lens. A
structured literature search was conducted on major biomedical databases using
predefined keywords related to transdental and immediate implant placement. Current human data indicate that implants
placed through impacted teeth can achieve high short- to medium-term stability
in carefully selected cases, but the evidence base remains dominated by small
case series and heterogeneous follow-up. Immediate post-extraction implants
demonstrate high overall survival in systematic reviews and randomised trials,
though slightly lower survival than delayed protocols have been reported in
some meta-analyses, and esthetic complications remain a key concern in thin
phenotypes or compromised sockets.
Across both approaches, outcomes appear highly dependent on
case selection, meticulous imaging-based planning, primary stability, infection
control, and soft-tissue management. Robust comparative studies with standardised
radiographic and patient-reported outcomes are needed before transdental
placement can be recommended beyond narrowly defined indications. A significant
research gap exists in the transdental field due to the absence of
well-designed prospective trials, standardised outcome reporting, and long-term
comparative data. Future research should prioritise prospective multicentre
studies and registries with standardised reporting of implant systems, surgical
protocols, radiographic assessment methods, and patient-reported outcomes to
enable meaningful comparison and evidence-based clinical recommendations.
Standardisation of outcomes is also recommended.
Author(s) Details
Bhushan Krishna
Chalmela
Department of Prosthodontics, Government Dental College and Hospital,
Chhatrapati Sambhajinagar, Ghati Hospital Campus, Panchakki Road,
Maharashtra-431001, India.
Ulhas Tandale
Government Dental College and Hospital, Chhatrapati Sambhajinagar, Ghati
Hospital Campus, Panchakki Road, Maharashtra -431001, India.
Kishor Mahale
Government Dental College and Hospital, Chhatrapati Sambhajinagar, Ghati
Hospital Campus, Panchakki Road, Maharashtra -431001, India.
Smita Khalikar
Government Dental College and Hospital, Chhatrapati Sambhajinagar, Ghati
Hospital Campus, Panchakki Road, Maharashtra -431001, India.
Vilas Rajguru
Government Dental College and Hospital, Chhatrapati Sambhajinagar, Ghati
Hospital Campus, Panchakki Road, Maharashtra -431001, India.
Sonali Mahajan
Government Dental College and Hospital, Chhatrapati Sambhajinagar, Ghati
Hospital Campus, Panchakki Road, Maharashtra -431001, India.
Please see the book here :- https://doi.org/10.9734/bpi/msup/v6/7130
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