Return to Upper Molar Immediate Implant Xin Wei, DDS, PhD, MS 1st edition 04/27/2014, last revision 05/28/2018

Plan for A 2nd Immediate Implant

As mentioned earlier, the 47-year-old lady has repeated history of swelling and pain associated with the upper 2nd molars.  The left one is more severely affected and has been extracted and an immediate implant placed.  Four months have passed.  The implant is supposed to get a permanent restoration.  But the patient develops pain in the upper right (Fig.1-5).  She wants to extraction and implant placement first. Implant placement at the site of #15 is fine except the torque being 45 Ncm.  To increase the insertion torque on the left side, round tapered osteotomes will be used until 4 mm at the depth of 17 mm, followed by 4.5-7x17 mm tapered taps.  If there is some space lateral to the last tap (7x17 mm) and bone engagement is not strong, a 8x17 mm tap will be used.  If the bone density is determined to be high by using osteotomes, reamers will be used for osteotomy. The autogenous bone will be harvested.  When a 7x17 mm implant is placed, almost all of bone will be used (Fig.2).  If a shorter implant is placed (7x14 mm), the most apical bone is not engaged (Fig.3,4).  Therefore the longer implant is required for increased torque.