[Surgery]  Immediate upper and lower premolars

I have had some success placing upper immediate 4's and 5's with crowns the same day. Drilling protocol used is similar to immediate anteriors to avoid buccal bone perforation. Usually place 4.0mm implants in these areas depending on the amount of bone of course.

Question is for example if you remove a 45 and there is a 44 and 46 present. Is placing right into the socket acceptable. I have gotten great stability and appropriate angulation on lower bi's but have not done any immediate crowns yet. Would best protocol be to graft where you can, PRF membrane, surederm and healing abutment. If you place a 4x10 in the socket and it sort of bottoms out but is still stable and you find it is not deep enough and the nerve is close by on the CT can you remove the 4 x10 and place a 4x8.5 or will you not likely get stability due to previous implant threads being in the socket. 



by Chad Denomme at Wed, Apr 12, 2017 7:17 PM

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Mark Kwon Replied at Wed, Apr 12, 2017 8:07 PM

ha ha... Great questions!

Those are very specific questions. And the answer is always "depends"

placing implants in md premolars can be very tricky due to high rising md nerve.

If the socket provides good position for the fixture and stability, "why not?"

However, removing and placing shorter implant may not result in good stability. Thus, choosing the right height at the beginning is important.

Also, remember, in premolar region, you dont always have to provide immediate provisional crowns. You can exo, socket and STI (whenever you can without compromising the result) and just place healing abutment.  Dont have to pressure yourself to provide provisional crowns in non-esthetic zones.  

Lower your stress = you will live longer ^^