Safety is Better Controlled with Immediate Implant
The apices of the lower posterior teeth (especially 2nd premolar and 2nd molar) are closely related to the inferior alveolar nerve and mental loop. Besides, the apices of the 2nd molar may be close to the submandibular fossa, related to intra- and post-op hemorrhage. Extraction sockets provide invaluable anatomic orientation clues. Immediate implant can be inserted into the confinement of the socket so that neurovascular bundle is not invaded. Immediate implant should be large enough to achieve primary stability and close the opening of the socket. Local anesthesia should not be too deep. Infiltration anesthesia is preferable than block. The depth of osteotomy is to be controlled well. Intraop PAs should be taken if necessary, to adjust the depth. Use an explorer or surgical curet during each step of osteotomy to check whether a lateral wall perforates or not. Severe pain or excessive hemorrhage may suggest invasion into the neurovascular bundle.
Xin Wei, DDS, PhD, MS 1st edition 01/01/2014, last revision 07/15/2014