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Achieving ideal position of Immediate Implant in molar region by drilling through interradicular bone in multi rooted teeth


Vikaskumar Patel, BDS, DDS

Anuja Patel, BDS, DDS

Osman Ali Khan, BDS


Purpose of the Study: Immediate Implant placement is becoming more and more popular because of ability to limit surgical procedures in one visit and patient comfort. While immediate implant in anterior region has challenges for achieving ideal esthetic result, posterior immediate implant presents its own surgical challenges like difficulty on osteotomy preparation. Immediate molar implant has several challenges including anatomical landmarks, need of atraumatic extraction and keeping as much as buccal and lingual bone intact. Success of Immediate implant is mainly depends on achieving good initial primary stability. Often after extraction of molar we are left with limited bone availability around socket area. Using interradicular septal bone to our advantage to gain primary stability improves the odds of implant osteointigartion. But preparing osteotomy bed for implant in that septa becomes even more challenging because that septa is not supported by adjusting root anymore. That leads to improper angulation or potentially loosing that septal bone. Here, case is presented to show how we can use that septal bone area for proper implant bed preparation before extracting tooth. Drilling through septal area with keeping roots intact gives septal bone much needed support for initial drills and also leads to better angulation for implant.

Methods: Basic Extraction instruments Surgical burs to section crown from the root Implant drills Bone graft cortical cancellous

Results: By keeping roots intact we improved the initial implant osteotomy preparation. Final outcome was achieved with very high initial stability 50N torque. Desired implant angulation and parallelism was achieved. 6 month evaluation of Implant showed successful implant osteointigration with good bone support.

Conclusion: Following this protocol gives us better chance to stabilize our initial drills in proper position and angel. This will improve chances of Immediate Implant success in molar area. Although this technique has given improved final outcome in our case, carful case selection is advised. Selection of case with enough interseptal bone to begin with is very important.

Articles: Implant stability measurements for implants placed at the time of extraction: a cohort, prospective clinical trial. Becker W, Sennerby L, Bedrossian E, Becker BE, Lucchini JP J Periodontol 2005: 76: 391–397 A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Lang NP, Pun L, Lau KY, Li KY, Wong MC. Clin Oral Implants Res 2012;23(5):9–66. Clinical and esthetic outcomes of implants placed in postextraction sites. Chen ST, Buser D. Int J Oral Maxillofac Implants 2009;24:186–217. Immediate implant placement into extraction sites: surgical and restorative advantages. R. J. Lazzara, International Journal of Periodontics & Restorative Dentistry, vol. 9, no. 5, pp. 332–343, 1989.

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