We created an immediate implantation surgical guide. This protocol brings together the practical experience of the Refformat surgical team. The guide was developed by the scientific group of the clinic under the leadership of Khyshov Maxim Vladimirovich.
We prepared a manual protocol for young doctors who start their surgical dentistry practice. The guide will tell you in detail about the operation of one-stage implantation. We described the entire process of surgical treatment: from the consultation and algorithm of surgical manipulations to postoperative management of the patient.

Protocol of immediate implantation

Modern methods of dental treatment:
Minimum time spent by the patient in the chair
Modern standard of implantological treatment
The painlessness of the surgical stage
Creating optimal conditions for prosthetics
Predictability of the result
Minimal injury the operation
Long-term clinical result and excellent aesthetics
Terms and criteria for immediate implantation
Immediately after tooth extraction
Immediate implantation
There is no healing of bone and soft tissues
The prevalence of the type in our practice
There is no healing of bone and soft tissues
Clinical situation during implant placement
About 6-8 weeks
Early implantation after soft tissue healing
Clinical situation during implant placement
Gum healing without bone healing
The prevalence of the type in our practice
We rarely use it. With immature tissues, it is difficult to analyze an X-ray and control the development of the inflammatory process.
About 12-13 weeks
Early implantation with incomplete healing of bone tissue
Clinical situation during implant placement
Gum healing and substantial bone healing
The prevalence of the type in our practice
A popular technique. The bone is more mineralized
compared to the early implantation period. A simplified drilling protocol allows the implant to be installed. We do not use a finishing drill and a tap.
6 months or later
Delayed implantation
Clinical situation during implant placement
Complete healing of tissues in the area of the socket
The prevalence of the type in our practice
We use it rarely, usually with large destructive processes of the jaws, for example, cysts from 2 cm in diameter
Indications and contraindications
Coincide with the indications for tooth extraction
Root caries
Root fracture
Chronic periodontitis of hard severity without exacerbation
Chronic granulomatous periodontitis (any periodontitis)
after elimination of acute inflammatory phenomena
Absolute contraindications
Heart attack or stroke
Diseases of the cardiovascular system
Obtaining the conclusion of a cardiologist 6 months after the onset of the disease
Conditions for implantation
We are waiting for 6 months from the onset of the disease
Our recommendations
Diseases of the endocrine system
Our recommendations
Consultation and treatment at the endocrinologist. After stabilization of the condition, control tests and a specialist opinion are necessary
Conditions for implantation
Glucose less than 7 mmol/ml,
glycated hemoglobin less than 7.5 mmol/ml.
Normalization of calcitonin levels
Radiation/ chemotherapy in the anamnesis
Oncological diseases
Our recommendations
If the maxillofacial area is irradiated, implantation is not possible.
In other cases, we wait for 6 months
Conditions for implantation
Obtaining an oncologist’s opinion after 6 months from the onset of the disease
Taking bisphosphonates
Our recommendations
Consultation of the attending physician regarding long-term replacement therapy, more than 6 months
Conditions for implantation
— Stop taking bisphosphonates 6 months before implantation
— Conclusion of the attending physician
— Stabilization of biochemical parameters
— Diabetes: glucose over 10, glycated hemoglobin over 8
— Diseases of the thyroid gland
Relative contraindications
Age under 18
Herpetic rashes
We are planning implantation after pregnancy. In case of acute inflammatory pathology, we remove the tooth at any stage of pregnancy.
The antibiotic amoxicillin is compatible with breastfeeding. During lactation, bone resorption prevails over osteogenesis. In our practice, no significant differences were found during implantation.
In the acute stage, we do not perform implantation.
The candidate's age is determined by skeletal maturation, not passport age. The closure of the main growth zones is determined by the X-ray of the hands. We perform implantation after the closure of growth zones.
Acute infectious processes in the oral cavity
Specific diseases
During the period of deterioration of the general condition of the body
Infectious diseases
2-3 days before the operation, we perform oral sanitation and prescribe rational anti-inflammatory and antibiotic therapy.
Implantation is carried out with in consultation with the attending physician.
Implantation is carried out in consultation with the attending physician.
Implantation is performed after stabilization of the condition. With arterial hypertension, it is carried out in consultation with the attending physician, under sedation and under the supervision of an anesthesiologist-resuscitator.
Example: cold, flu, high blood pressure
Rational antibiotic therapy is important.
Example: with viral liver damage, fluoroquinolones are allowed: Levofloxacin, Clinafloxacin, Ofloxacin, – and penicillin group antibiotics: Ampicillin, Ampisid, Ampic, Azlocillin.
Example: syphilis, actinomycosis.
The first days of the women's cycle
Cosmetic injections
The pain threshold and blood coagulation are reduced. We recommend postponing surgical procedures for a few days.
We recommend postponing the operation for 7−10 days, the formation of hematomas is possible.
Initial consultation
Find out the patient’s complaints and expectations. It is important to discuss the duration and stages of treatment, and to inform about possible complications.
We collect information about the patient's bad habits and chronic diseases.
An orthopedic surgeon makes a comprehensive treatment plan. The implantologist pl an implantation.
Collection of anamnesis and conversation with the patient
Сбор анамнеза, обсуждение ожиданий пациента, знакомство
Данные внешнего осмотра челюстно-лицевой области
Диагностика патологий ВНЧС, особенности открывания рта
Biotype and condition of soft tissues
The presence of bridles
Dental formula
Examination of the oral cavity
Осмотр слизистой оболочки полости рта и красной каймы губ
The required amount of oral cavity sanitation before implantation
Прикус, его патологии, зубная формула
План лечения, этапность хирургии, ортопедии, терапии
Bone height in the implantation area
Proximity of the maxillary sinus
Proximity of the mandibular nerve
X-ray analysis
The presence of inflammation, cysts, fractures of the tooth
Presence of multiple chambers, sinus septa
Bone height in the implantation area
Proximity of the maxillary sinus
Proximity of the mandibular nerve
Analysis of a 3D Cone Beam Tomography Image
The presence of inflammation, cysts, fractures of the tooth
The presence of several chambers, septa in the sinus
Thickness of the cortical layer
Density of spongy bone (A tool in Viewer)
Resorption of the cortical plate
Thickness of the vestibular bone
Sublingual recess
Discussion of the need for treatment under sedation
Indications for treatment under sedation are
Large volume of surgical intervention
Aggravated allergic anamnesis
Pathologies of the cardiovascular system
Necessary analyses
Electrocardiogram (ECG)
Detailed biochemical blood analysis
General blood test
The analysis for hospitalization is an analysis for HIV, syphilis and hepatitis B and C.
Occlusal and side mirror
Soft tissue retractors
ISO 100
Photo protocol
Aperture F22-29
Shutter speed 1/160
You will need:
Camera Settings for Canon:
Why conduct a photo protocol
Preoperative preparation and planning
How to process a patient
Aseptics and antiseptics
Hand Preparation
How to set up the operating table
Operating table instruments
Lowering handpiece 1\20
Step-up handpiece
Suture material
Needle holder
Korntsang for processing the face and oral cavity of the patient
Carpules with anesthetic
Farabeuf Hook/Minnesota Retractor
Sterile saliva ejectors with adapter
Curved tweezers
Anatomical tweezers
Universal curette
Curette spoon
Sickle trowel
Periodontal probe
Dental rasp (xyster)
Scalpel and disposable blades 15C, 12D
Metal bowl for collecting autobones
Carpool syringe
Sterile gauze wipes
Antiseptic preparation for the treatment of the patient’s hands and face
We also use:
Aqueous solution of chlorhexidine bigluconate 0.2%
Bone-plastic material Bio-Oss or other osteoconductive dispersed material
Implantology Kit
Equipment for the operation
Liston centrifuge, model C 2204. We use it in the 3000 rpm mode, 20 minutes to make a PRF membrane.
This centrifuge is a matter of pride of Russian production.
Tooth Extraction Tools
straight forceps
bayonet tongs
S-shaped forceps
Forceps for removing wisdom teeth in the upper jaw
beak forceps
Elevators with a flattened working part 3–4 mm, with a narrow working part for anterior teeth - 1.5–2 mm
It is possible to use luxators, but they are thinner than elevators, so they will not be able to give a full force.
Elevators and Luxators
Immediate Implant Protocol
We divide the anesthetic cartridge into 5–7 injections in order to avoid hydraulic fracturing of the underlying tissues.
1–1.5 carpules are injected from the vestibular side according to the type of infiltration anesthesia, 1/3 carpules are injected from the palatal side.
PRF / Platelet Rich Fibrin is a platelet-rich fibrin clot.
After anesthesia, we take 8 ml of venous blood for the manufacture of PRF, use a 9 ml Vacuette tube with filler. With the action of adrenaline, the membrane is of better quality than when taking blood before anesthesia.
Making a PRF Membrane
according to the personal practice of anesthetists at the Refformat clinic.
The blood is centrifuged at 3000 rpm for 10 minutes.
Comfortable for the patient
Criteria for a successful tooth extraction
We use carbide burs for sawing the crown part, this will help avoid unpleasant odors.
Carbide bur for crown fragmentation
Lindemann cutter with extended part
5:1 step-up handpiece

Fragmentation of teeth
Turbine handpiece is not intended for surgery
Required tools:
After separation of the crown part of the tooth, we remove the vestibular wall of the root with a cutter.
We form a cut in such a way as to form a space where a fragment of the tooth root will be moved when the elevator moves.
Fragmentation of single root teeth
We focus on the initial state of the tooth. With the preserved crown part of the tooth, we cut in the projection of the furcation and remove the roots with an elevator.
We form a cavity with a cutter in the cervical zone of the tooth, on the border with the bone, under the working part of the elevator. We make a cut in the projection of the extraction of the root.
Fragmentation of multi-rooted teeth
We determine the trajectory of extracting a fragment of a tooth, depending on the point of application.
We form a site with a triangular bur according to the standard protocol.
When working with pilot drills, the rotation speed is 500–700 rpm.
The use of irrigation avoids overheating of the bone. Osteoblasts are destroyed at 47°C.
Formation of the implant site
We exclude additional trauma to the bone due to continuous reciprocating movements.
The positioning of the drill is carried out in the palatal or lingual wall of the socket or in the bi/trifurcation region, since these zones are more stable. The cortical vestibular plate is thinner and less supplied with blood.
We set the bur in the correct orthopedic position, and do not focus on the contour of the socket.
The depth of drilling is determined relative to the lower bone edge.
When forming the bed, we determine the trajectory of the position of the implants using the parallelism pins.
For dense bones, use special drills.
The implant is placed in the center of the ridge, closer to the back wall of the socket. Orientation along the line of fissures.
We evaluate the correct position of the implant after healing of the socket and bone remodeling.
The thickness of the bone around the implant is more than 1 mm.
Implant placement
Bone remodeling after immediate implantation is about 1.5 mm in height.
The implant is installed palatally relative to the projection of the root.
Formation of the implant site
Forming cutter for the entire intended length of the implant with a mode of 500–700 rpm.
Basic drilling: 250 rpm, no irrigation for bone collection.
Bed preparation algorithm
At each stage of drilling, we check the position of the implant with a parallelism pin.
Прецизионное сверло Precision Drill (дополнительно)