Septal Entry for Immediate Implant

A 54-year-old lady reports severe pain in the lower left 1st molar after biting on a small piece of spice (Fig.1).  The symptom and sign are consistent with crack syndrome.  There is periapical radiolucency (*).  The neighboring tooth has a chip (>).

Fig.2 shows that the top (^) of the septum (S) is rounded after extraction.  It is difficult to make an entry with a pilot drill (Fig.3 red arrow); the drill easily slides into either the mesial or distal socket (short arrow). 

To overcome this difficulty, a slot is made on the top of the septum for a few millimeter deep with a surgical fissure bur (Fig.4 blue dashed line).  With this flat plane, the pilot drill will make a stable entrance into the septum (Fig.5).  This step (slotting) is also critical in dictating that the implant will be not placed too buccally with black shadow (Fig.18).  Finally, a tissue-level implant is to be placed (Fig.6, as large as 7x14 mm).  An immediate provisional will be fabricated since the patient is leaving in 2 months.

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Xin Wei, DDS, PhD, MS 1st edition 01/02/2015, last revision 02/25/2015