[Surgery]  Immediate mx premolar Implant placement?


I think I can extract 15 and replace with 4.3x13mm tapered groovy or active without sinus lift. what do you think? Tooth has had lingual cusp fracture below the bone and non restorable with a non-symptomatic apical lesion.

by Mark Kwon at Fri, Sep 23, 2011 1:45 AM

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Bernard Jin Replied at Fri, Sep 23, 2011 1:27 PM

The proposed treatment appears sound ~ extraction with implant placement. In addition to Mark's comments above - I would caution the patient that immediate implant placement is NOT a sure thing. The radiograph shows a periapical lesion (saggital & coronal views) that may well lead thru the buccal cortex and/or the sinus floor. This could complicate matters. If you suspect exposed implant threads or are unable to achieve initial stability upon insertion - consider performing a ridge preservation and an attempt another day. Lastly - I would suggest evaluating the adjacent dentition. Do you see any pathology - as this can certainly contribute to the success/failure of the immediate implant. - Bernard

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Mark Kwon Replied at Fri, Sep 23, 2011 1:53 AM

Thx for the post. Whenever, I consider whether I should go for immediate implant or not depends on several factors: 1. Force factor = This is Important! Often many doctors overlook this. Especially if the natural tooth is being lost due to lingual cusp fracture; Must rule out parafunctional habits or unusual occlusal factors 2. Availability of the bone : How much bone is remainig once you perform atraumatic extraction? I personally like to see at least half of my implant fixure in the native bone after the extraction for good primary stability. I particularly like to look for bone palatal to the socket site, since it has the most dense bone in respect to root position. 3. Can the remainig lesion be thoroughly cleaned? whether the lesion is symptomatic or not , it MUST be removed. Use of Lucas currette or long-shank rough diamond bur may be warranted. Looking at the radiograph you have posted, I think it may be close but doable. Please go back remeasure the amount of bone palatally. If you are immediate socket grafting and temporizing, make sure you get rid of lasteral excursive force and out of centric occlusion. See you at the OLSC! - Mark