Introduction to Immediate Implant for Upper Bicuspids

The upper biscupid has an oval socket, particularly the first.  The immediate implant is recommended to be placed palatally.  When a gingiva-level implant is used, there is a buccal space.  The latter can be closed by advancing a flap, which may compromise gingival esthetics.  The best way to close the remaining socket is to fabricate an immediate provisional (2).  In addition, an upper bicuspid may be in cosmetic zone.   Immediate provisional keeps bone graft and the adjacent papillae in place.  The 2nd method to keep bone graft and membrane in place is to install an abutment, which increases physical retention of perio dressing.

When a bone-level implant is placed, the socket can be closed by soft tissue graft, bone graft and membrane, and placement of healing abutment with bone graft and membrane. The patient may wonder why a crown cannot be placed immediately when the immediate implant is stable.  In all, immediate provisional is in demand.

Primary stability is achieved by gaining osteotomy in the new bone (a long implant) or make the socket larger (a large implant). 

Types of Implant for Immediate and Delayed Placement

Soft Tissue Level Bone Level D implant 1-Piece
D2 Bone Dummy Implant Subcrestal Placement #13 Crack 3.8 or 4x15 mm Implant Why Small Diameter Implants 2
Immediate Provisional As palatal as Possible, CT Follow-up Off-Axis Implant #5 Long Bone: PA Post 1st Drill Soft Bone 2 Roots Limited Space
Instant Ortho Implant Placed 2 week post Extraction Keep Partial #12,13 Low Stability Overload 4 Prevent Periimplantitis
Abutment & Periodontal Dressing Over-Contoured FPD, Dual System Fails (From Bicon to Tatum) #13 Root Tip Curves Distal Long Term F-U 10,12 Narrow Ridge
Depth & Position Fearful Patient, Narrow Implant Socket Preservation, 2, Redo Crown #4 Distally Deviated Root, Shifting of Implant   12 Narrow Space
Next to Infection Periimplantitis Implant/Root, Low Torque #4 PARO 2 Point Engagement, Done as Planned    
Close Call Implant (2) Prior to Veneers Residual Root, Placement #4 Crown Fracture, Next to PARL, RPD Clearance    
Depth of Bone Graft Tough Decision Narrow Pontic, Low Torque #4 Extraction Extraction For A Molar Implant  
Long Root Tapered Modified Periimplantitits PRF Deciduous Tooth, Expanders #4 Vertical Root Fracture Post Apicoectomy Long    
Where to Graft #13 Root Fracture,Trajectory Correction Dense Bone, Sinus Floor #4 Crack, 4x16 mm Implant Placed Deep    
Narrow M-D Space, 1-, 2-Piece #2,4 FPD Dislodges Sinus Lift Master Kit Trajectory Sinus Perforation Screw Retain 12,13 Sinus Lift for 14,15 Implants    
Close to Sinus 13 Root Fracture UF Long Implants 12 Short Bone/High Torque Implant    
Curved Root No Drill 5 Occlusal Trauma & Endo Failure Narrow Edentulous Space Narrow Implant #12 Endo Failure with Perio/Bruxism Deep Placement    
Under Prep Change Position 12 Residual Roots Sinus Septum #13 Unlimited Bone, But Soft    
Improvement Modification 4 Sinus Membrane Repair Crack Tooth; Sinus Lift 13 2 sockets PARL    
Sinus Septum 2 4 UF Guide for Tatum Long Implant Placed in Uneven Bone 13 Sterile Sinus Lift 5 Root Amputation 13 Osteogen Plug
Dense Bone Early PA, Redo Plan, Redo 5 Prevent Periimplantitis Sinus Septum, Unintentional Sinus Lift 3,4 Loose Bone Guide No Tap    
Density Extra Measure, Buccal Margin 5 Residual Root Narrow Implant Long Implant Shy of Sinus 12 Buccal Perforation    
Two Adjacent Implants No Prep 2-4 FPD Failure Socket Shield, Increase Vertical Height 13 Sinus Lift 15 mm Implant    
    Improve Implant/Bone Ratio 4,12 Large Defects, Large Implants    
    Immediate Implant without Drill 5 Crack Palatal Subgingival    
    Change Trajectory Early 13 Immed,14 Delayed Deviation of Trajectory    
    Long, Narrow Implant Placed Deep 13 Immediate 15 Delayed Implants    
    #3,4 Residual Roots:Underprep No Prep 3,4 Buccal Recession    
    #4,5 Long Implants, Less is More 13 Distopalatal Entry    
    #5 Curved Root, Smoker 4 Post 2 Fistulae    
    #4 Post-Induced Root Split 5 mm Implant      
    #13 Increased PDL Sinus Floor Perforation 13-15 No More FPD    
    Failing FPD 2-4, Dual Modes 4 Buccal Apical Defect    
    #13 PRF with Sinus Lift, Trajectory Change      

Return to Immediate Implant Immediate Implant Complications Xin Wei, DDS, PhD, MS 1st edition 02/16/2014, last revision 02/09/2020