Immediate Implants for the Lower Bicuspids (Anatomy)

The lower bicuspids (particularly 2nd ones) are closely related to the mental nerve loop.  Immediate implants are much safer than the traditional ones if the osteotomy is confined to the original socket. 

For primary stability, there is no necessity to let the implant engage into apical new bone.  Instead, a relatively larger implant (5.3 mm or more in diameter) should be used.  The only minor drawback is metal show. 

Socket preservation vs. Immediate Implant (1)

Cases

1st Bicuspids 2nd Bicuspid
"Implant is so strong" No Distal Tooth #29 Root Fracture Single Drill
"No Pain" Isolate Tooth #20 Long Roots Long Implant Mental Loop
Early, Over Loading Fracture #29 Periimplantitis: Immediate Redo
Double Mental Loops Ideal Trajectory #29 Large Radiolucency Close to Loop
1-Piece Implants for Narrow Ridge Safety vs. Trajectory #29 Osteoporosis, Underprep
Pointed Ridge after Long term Loss of Function Next to Infection #20 Close to Loop, RPD as Surgical Guide
Pointed Crest, 1 Piece Narrower Crest, Resection From Bridge to Implants #29 Distally-Deviated Root, Just Avoid Loop
Deviated Root Reposition Root Length, Mental Loop #29 Avoid Mental Loop; 11.5 mm Implant
Anchorage, Deep Placement, Banding, #29 Redo Change Long Axis Soft Bone Next #19,20 Perio Abscess Post SRP
Mesiolingual Osteotomy; Over Lingual Placement Fenestration Repair Hard Bone #18-20 FPD will be Sectioned Twice No Drill Osteotomy
One Stage: Implant, Abutment, Graft, and PRF Endo Perio Disease Crowding 2 Premolars: One Tooth Width Underprep
Narrow M-D Space, Buccal Plate Atrophy Depth & Mental Loop, Malposition, Reposition T Retains Bury Threads;  Mental Loop
3.8x16 mm implant/5.5x5(5) mm abutment Supraeruption & Occlusal Clearance, No Immediate Provisional 29 Severe Periodontitis: Deep Placement
Perio, Angled Abutment Short, Small Implant Immediate Re-placement Extra Wide 29 Soft Bone: Bone Expanders, BEB, Cortical Tap
20,21,28 Ball Abutments Change Trajectory Early 29 Narrow Space and Ridge
28 Distolingual Osteotomy Low Density Cancellous Bone (#20), 28,29 29 Post Apicoectomy
21 Add Ball Abutment for RPD Retention Residual Root Next to Narrow Ridge 29,30 FPD Removed
28 Exfoliation, Ridge Narrow or Wide? Narrow 3-D Space Bending 20 DO Caries
21 Lower Lingual Crest Treatment options for #29 with PARL 14,15,29 One Appt Increase Implant Length
21 Narrow Ridge after Traumatic Extraction Implant at Failed Site with Bone Loss 29 Next to Necrosis Using Next Implant as Anchor
21 Subgingival Fracture, Unexpected Shield Wide Mesiodistal Space X-ray Angulation 29 Redo Shorter than Guide Design
28 Implant with Ortho Retained Deciduous Molar Dense Bone 29,30 Splint Provisional
21 IS Guide for IBS Implant Post Socket Preservation Bone Expansion 29 Equigingival Fracture
28 Concave Fix 31 18 Buccal Defect Lingual Placement 21,29 Narrow M-D Space
21 BioXclude 85y/o   20 Lingual Abscess Lindamann Bur
    20 Thick Lingual Plate

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Xin Wei, DDS, PhD, MS 1st edition 03/10/2013, last revision 12/24/2019