IMMEDIATE MOLAR IMPLANTS: Hi Mark,   Firstly, would you recommend placing an immediate temporary crown on an immediately placed implant? What model amongstthe Nobel - Active? for lower molar. And any precautions regarding the graft? Thanks.  Answer: from Mark One of the most difficult procedure to do is immediate molar implant.  Osteotomy needs to be precise. Among Nobel family, Active seems to work the best due to it's aggressive apical cutting surface. Do not need to use bone tap.  Make sure implant stays lower than buccal bone level. I do graft the empty void sockets using allograft material such ad osprey cancellous. Definitely not recommending to place immediate temp until you gain a lot more experience with these. Analyze the CT scan very carefully since often the operator may accidently act over-aggressively during the drilling protocol to achieve stability.  Make sure you DON'T hit nerve!!! Take care, - mark

by Mark Kwon at Fri, Feb 18, 2011 12:54 AM

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Bernard Jin Replied at Tue, Feb 22, 2011 3:53 AM

I agree. Immediate implant placement is complex enough, let alone - doing it in a molar site and possibly performing an immediate temporization alongside it. Please keep this in mind - it is a challenging task. Having said that, the problems I find associated with immediate implant placement in the lower molar are: - lack of bone to engage (simply due to the nature of the pre-existing root volume) - non-ideal implant placement target (meaning you typically are aiming to place your implant right at/through the septum between the mesial & distal root) - anatomical considerations (sub. mand. fossa, IAO nerve & artery) For such reasons, I would typically not make any promises for an immediate implant placement. If it happens, then everyone is happy. But I wouldn't recommend promising anything. If in doubt, pursue the treatment with socket preservation - along with the extraction. Then you could always return to place the implant at your desired spot another time. Hope that helps! Bernard