Where to Place Immediate Implant at Lower 2nd Molar?

A 35-year-old man wants to restore the tooth #31.  The root is conical in shape (Fig.1).  It is natural to start osteotomy at the apex of the socket and along the long axis of the socket (Fig.2 red arrow), but the end result is that the immediate implant (Fig.3 black area) is not aligned well with the mesial and distal crests (pink areas; yellow dashed line: upper border of the Inferior Alveolar Canal).  If this bone-level implant is level with the mesial crest, the distal threads will not be covered by the native bone.  The distal threads may be exposed.

To correct this tendency, draw an imaginary line connecting the mesial and distal crests (Fig.4 white dashed line), bisect the imaginary line and initial osteotomy (red arrow) in the mesial slope of the socket (^).  When a bone-level (Fig.5) or tissue-level (Fig.6) implant is placed, there is less chance of thread exposure mesiodistally.  Bone graft (red circles) is placed to close the remaining socket gaps.  If necessary, an incision is to be made to visualize exposed threads.  Will this be done properly?

Return to Lower Molar Immediate Implant, Dr. Wu

Xin Wei, DDS, PhD, MS 1st edition 03/31/2015, last revision 04/26/2015