[Diagnostic / Planning]  immediate implant for 24

Hi All,

I would appreciate your advice regarding this case. I am familiar with the immediate molar and immediate anterior but for this bicuspid with two roots would you do an immediate implant and temporary?

I am happy with the length of bone available but am concerned about the void that will be left by the palatal root. Normally I'd remove the tooth and graft then easy implant 6months later but this patient is very concerned regarding esthetics and wants an immediate temporary. Is this a viable option with Sureoss and PRF? Or would you stick with the stage approach? What do you think about the placement of the 4x 15 implant on the Ct? Can't do bonded temp because 25 crowned.



by Cindy Sidhu at Thu, Feb 16, 2017 9:40 AM

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Mark Kwon Replied at Fri, Feb 24, 2017 1:46 PM

Hi Cindy,

i do immediate on premolars often, especially on first premolars. 

I would stay little more palatal since it is easier to graft the buccal jump gap than the palatal. 

Take it out of occlusion at CO and Excursion. 

Good luck!

- mark

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Ho-Young Chung Replied at Thu, Feb 16, 2017 2:06 PM

Hello Cindy,

Thank you for posting this case.  Whether or not you place immediate implant, I recommend making a temporary crown at some stage of treatment.  HiOssen does have the best array of healing abutments on the market in my opinion but in an aesthetic area with an aesthetically demanding patient, there is no substitute for temporary crown for building proper emergence profile.  

You will end up with a jump gap likely both on the buccal and palatal aspect.  You can graft both B and P with allograft.  I use cancellous bone for faster turnover but cortical bone or 50/50 mix will work too (just takes longer for it to turn over).  

Every temporary crown needs to be protected (I give an Essex stent with that temporary crown cut out) and patient compliance especially for premolars is vitally important.