Why is Immediate Implant necessary?

Mrs. Wang, in her 60s, has lost 5 teeth on the top, which are replaced by a partial denture.  Several months earlier one bottom 2nd molar was broken down (Fig.1: 2).  Against our advice of immediate implant, she had the tooth extracted somewhere else; now she feels that she needs an implant to chew, but she has lost fair amount of bone (Fig.2 arrow).  The delayed implant has less bone for support with increased opportunity to be loose.

Mrs. Wang's nerve in the bottom jaw is not clear before extraction (Fig.1 ?) and remains unclear after extraction (Fig.2 ?).  It is unsafe to place an implant there.

On the other hand, there is a technique to place an immediate implant (Fig.4 green) in a fresh socket (Fig.3 black area).  In most of cases, the nerve is outside of the socket.  If the implant is placed within the socket, the nerve is the least likely to be touched.  When the socket heals several months after extraction, it is extremely difficult to know the boundary of the previous socket.  The chance to damage the nerve is higher unless CT is taken.

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Xin Wei, DDS, PhD, MS 1st edition 12/11/2016, last revision 12/11/2016