Immediate Mandibular Molar Implant Placement
Diplomate - American Board of Periodontology
Diplomate - International Congress of Oral Implantologists
When discussing immediate implants, mandibular posterior teeth are often overlooked. This is quite unfortunate because I have found this area to be one of the most predicatble sites for immediate implant placement. The following is a small series of cases demonstrating placement of immediate implants in mandibular molar sites.
CASE 1
Non-restorable tooth 18.
Tooth 18 is extracted, 5x13 mm implant fixture placed, grafted with FDBA.
Healing at 3 months. Note the bone fill around the implant.
Healing abutment at stage 2 and 6 weeks later.
CASE 2
Non-restorable tooth 18.
Tooth 18 is extracted, a 5x13 mm implant fixture is placed, graft with FDBA.
Healing at 3 months. Impression with impant analogue/impression coping. Fixture abutment in place prior to crown delivery.
Radiographic series of pre-op, immediately after implant placement, and at 3 months.
CASE 3
Non-restorable tooth 19. Tooth 20 was previously extracted and replaced with an implant fixture.
Tooth 19 was extracted and osteotomy was created into septal bone. Direction indicators in place.
Implant fixture is placed, grafted with FDBA, and flap is advanced to obtain primary closure.
Radiographic series of implant fixture placement. Note that when implant was originally placed, it drifted mesially into the root socket. This caused implant to lose parallelism with the adjacent implant and tooth. The implant was back up a few turns, re-angled, and placed to a more parallel position. After final position was achieved, the defect was grafted with FDBA.
Healing at 6 weeks.
CASE 4
Non-restorable tooth 30 (vertical root frature). Site 31 is also planned for implant.
Tooth 30 was extracted, a 5x13mm implant fixture was placed, graft with FDBA and cover with resorbable collagen membrane. An implant fixture was also placed at site 31.
Healing at 3 months.
Lab analogues with final restorations.
While anterior and maxillary implants tend to get the most attention as far as immediate implants are concerned, mandibular posterior teeth are a great yet often overlooked location for immediate implants. The thick buccal and lingual walls allow for excellent bone formation without much of the resorption that you may see with thin facial plates in the anterior maxilla/mandible.
I hope you found these few cases interesting.
Thank you.
Dan
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Comments
very nice technique and images
these cases are great to see. this is my prefered technique for placement following extraction in the absence of infection. thanks for the posting
if there is interest I can share some images from immediate placement in the maxillary arch combined with closed sinus lift technique in molar and premolar area.
Holtzclaw case #1
Did you get a CT? The fixture looks extremely close to the IAN. After 20 years and 7,000 cases, I find myself using more diagnostics rather than assuming that if the roots worked an implant will as well.
Any anesthesia/parasthesia?
No paresthesia or anesthesia.
Deden,
No paresthesia or anesthesia with this case.
I agree that pre-op dx is key. Unfortunatley, I have no CBCT of this particular case.
Immediates in the sites of 2nd molars require close attention to detail. IAN is typically a bit closer in this location.
Wide Implant in Molar regions...
Salama January 8th, 2010
For all interested…An excellent 2 part lecture on this very topic can be found on www.DentalXP.com under the follwoing heading and attached link.
Take a look. It is an excellent lecture.
Dr. Salama
Immediate Implants in Molar Sites - Wide Diameter Implants: Part 1 and Part 2
Dr. Murray Arlin highlights the advantages and disadvantages of immediate implant placement in molar extraction sites.
Presented By: Murray Arlin, DDS, dip. Perio., FRCD
Presentation Style: Lecture
Community Rating:
Watch Now>>
http://www.dentalxp.com/video/immediate-implants-molar-sites-wide-105103...
Immediates to many failures......Neat Video on Dental XP
I still think immediates are risky as I tend to graft and come back. Reduces failure rate.
On a different topic, neat site, looks like nice video education. I always wonder how people film videos, the mouth is such a small place.
Advances in technology. Thanks for sharing.
Honestly, membrane did not seem to matter
As you can see in this little presentation, the first 3 cases did not use membranes and the 3rd case did use a membrane. I have done alot of these both ways and, to be quite honest, the membrane did not seem to matter. Likely because we are dealing with a 4 wall defect. I currently cover these sites with a PRF membrane. The PRF is very inexpensive, easy to perform, and adds growth factors to the site.
membrane
Great work.....but i want to get this clear, are you using a membrane to cover bone graft?
Nicely done
How do you achieve the primary closure? I do the same technic, but am always a bit short of soft tissue for full closure of the grafting material ( especially on the upper molars).
A. Butkevica, MD, DMD, Prosthodontics and Implantology, DSc
Primary Closure Question
Alena,
Thanks. Some people do not try for primary closure in this situation, but I do. Just my personal preference. I usually have to place a couple of vertical incisions with an additional periosteal releasing incision to achieve closure. Additionally, the flap usually must be recontoured to adapt to the abutment. If you do not do this, you will have gaps at the crestal incision line or the flap will ride up over the healing abutment.
immediate loading molar
Someones know articles relate to this subject ?
May this approach be dangerous for achievement osseointegration ?
Roberto Calandriello
Bologna
Italy
Nice Immediate implant
Great job Dan. Immediate implant definately the way to go.
I had tried some cases where implant was placed in the septum but without bone graft, just filled the socket with blood clot and a figure 8 suture. Cases turned out alright, but didn't do enough to call it a " predictable procedure".
Patients get less swelling and post opt pain. Reduce cost of membrane and bone graft. What are your thoughts?
Thank you for the nice comments. A question for SNALBAND.
Thank you for all for the nice comments. I am happy if anyone gleened any information from these cases.
A question for SNALBAND: Are you doing flapless surgery with immediate molar implant placement? I am not doing flapless with these because I like to make an attempt at primary closure when placing these (just my personal preference).
Can you send some pics? We would be happy to post cases from other providers if anyone is interested in sending any over.
Thanks!
Dan
Nice approach!
Thank you very much Dan for your cases.
Indeed this is a great work you did and it's not an easy way to do it.
I hope you will show us more cases.
It requires some implant placement experience, it's not for beginners and requires some special technique and armamentarium to prepare the septum, special design implants and so on.
Looks so simple in your hands!
Keep up the great work.
Immediate molar implants
At last I found a colleague who agrees with an immediate molar implant placement. I have completed considerable similar cases and commend you for your excellent images. My only comment is that, I use piezosurgery for my initial osteotomy and flapless surgery. Piezosurgery assisted osteotomy is an excellent modality in areas with good spreading of the bone or direction of initial osteotomy for optimal implant positioning.
Sarkis Nalbandian
Prosthodontics & Implant Surgery
Sydney Australia
Nice Immediate Molar Series! Great pics.
Very nice job on those cases Dan. I am in total agreement with you. Immediate molar implants are a great option.
Not for amateurs or part time implant users though. Very technique sensitive. Not only do you have to drill down a triangular sloping septum without sliding down the sides, you also have to be conscious of where the inferior alveolar nerve is. Some high risk with this procedure if you do not know what you are doing.
Those pictures were spectacular. Thanks for posting and please add more!