Immediate Implant for Back Tooth

Mr. Chen, in his early forties, has infection in a lower back tooth (Fig.1 >).  CT shows a large abscess between the roots (Fig.2 *). After discussion, the patient agrees to have extraction and immediate implant (Fig.3,4 I).  The two procedures are condensed into one, saving time (in terms of months) and discomfort.  Since the bone has not shrunk, a large implant is able to be placed (7 mm here vs. usually 4 mm).  The infection goes away a week after surgery (Fig.5 <, compare to Fig.1,4).

A thick gum band forms around the implant 7 months after surgery (Fig.6 *, as compared to Fig.4).  This is a normal structure.  Bone also heals normally around the implant (Fig.7).  The most exciting finding is the formation of the papillae (Fig.8 *, another type of normal gum structure) when the permanent crown is seated.  The papilla helps prevent food impaction between the teeth.  The cosmetic and functional result is due to immediate placement of the large implant.  In contrast, the papilla may not form readily in cases where implants are placed several years after extraction.  There is no bone loss around the implant 9 months after crown (Fig.9 C) cementation.

In brief, immediate implant is the best method to control infection and lead to complete rehabilitation of oral structures.

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Xin Wei, DDS, PhD, MS 1st edition 12/13/2013, last revision 07/09/2015