Bone-level Immediate Implants

A 43-year-old lady has generalized moderate localized advanced chronic periodontits (Fig.1,2).  In spite of 4 quadrant scaling & root planing, the tooth #19 develops 2 perio abscesses (Fig.4 with insertion of 2 guttae perchae); periodontal ligament spaces increases (compare Fig.2,4).  It appears that the tooth is non salvageable and should be replaced with an immediate implant (Fig.5).  The extraction socket will be treated with Metronidazole.  A 2 mm pilot drill is used to start osteotomy in the septum (14 mm deep), followed by reamers until 3.5 mm.  A 5x17 mm tap is placed to test stability.  If the stability is high, place a 5.3x12 mm SM implant.  If insertion torque is too high, use the corresponding drill before re-place the implant.  Collagen dressing is placed in the peripheral and deep portion of the sockets, while bone graft in the top portion of the sockets (near implant threads).  Use 1 or 2 amalgam carriers to deliver the graft lateral to the implant precisely so that a cover screw does not have to be placed.  Next place a cemented abutment.  If trajectory of the implant is correct, an abutment as large as 7.8x5(3) mm could be used (pink).  Fabricate an immediate provisional.  Do not over trim the margin of the provisional so that it can cover the socket completely.

Return to Lower Molar Immediate Implant

Xin Wei, DDS, PhD, MS 1st edition 07/02/2015, last revision 08/18/2015