Is Immediate Implant an overkill?

When Mr. Wu presented to our clinic 2 years ago, his bottom right 2nd molar (Fig.1: #2) was sensitive after crown cementation.  He returned to Florida for root canal treatment.  When he returned to our clinic again, a root of the tooth cracks (Fig.2 arrowheads).  Ideally the tooth should be extracted immediately (Fig.3 S: socket).  An implant placement should be started through the open socket (Fig.4).  The advantage is that the gums (Fig.4 purple dashed line) are spared from drill (green line).  Pain associated with traditional implant placement (non-immediate implant) is due to cutting the gums.  When an immediate implant is placed (Fig.5 I (green area)), the gums remain undisturbed (no or less pain).  When the tooth is just taken out, the bone is big.  A much larger and longer implant can be placed, as compared to the implant at the site of the 1st molar (Fig.1: I). The remaining socket space is filled with bone powder (Fig.6 red circles).  If the immediate implant is stable, an abutment (Fig.6: A (pink area)) can be placed and an immediate temporary crown (C (yellow area)) can be cemented.  The socket opening is able to be closed completely.  The pain will be minimal.

But the patient did not pay attention to our suggestion and went to his home country to have the tooth extracted without immediate implant or bone graft.  Now the socket heals (Fig.7).  To place an implant, the gums have to be cut open (Fig.8 red line (bleed and pain)) and dragged aside (curved arrows).  The gum manipulation is to make room (Fig.9 black area) for digging out a lot of just healed bone (Fig.10 arrow) so that an implant can be seated (Fig.11 green area).  Last the gums are pushed back (Fig.11 purple dashed line) and tied together (white lines).

In brief, an immediate implant is absolutely not an overkill.  Instead it helps the patient.

Return to Implant Xin Wei, DDS, PhD, MS 1st edition 07/01/2015, last revision 10/27/2019