Lower Molar Immediate Implants

In this section, three topics are discussed.  Where to place implant?  Bone graft is necessary?  CT is mandatory?

To answer the first question, we need to know which molar to receive implant, whether the septum is present or not, and the size of the septum.  The first molar has two widely separated roots.  The implant should be placed in the septum.  Osteotomy is initiated in the septum either before or after extraction of the roots.  If one socket is severely affected, the implant should be placed in the other healthy one; the septum should be pushed to the affected socket using osteotomes so that the implant is finally placed more or less in the center of the socket.  If the one socket is too large, the implant may be placed in the other socket. In case one socket is close to the root of the neighboring tooth, the other socket should be chosen as an implant site.  When the septum is destroyed by lesions, the largest implant is placed in the socket.  The second molar usually have fused roots.  A single large implant (2) is placed to prevent socket collapse post-extraction and achieve ideal restoration.  When the second molar has two separate roots, the implant may to be placed in the mesial socket or the septum.  For a single socket of the 2nd molar, the implant still has to be placed in the middle of the socket or in the mesial slope of the socket.

Is bone graft necessary for immediate implant?  It should be case dependent.  Bone graft is not necessary as long as osteotomes and reamers are used, large implants are placed, and the remaining space is small.  When the socket defect is large and implant threads are exposed, bone graft is essential to close the space and prevent periimplantitis.  If the latter does happen, bone graft after debridement is a practical solution.

Is CT mandatory?  Probably not.  But it is when the inferior alveolar nerve or mental loop is not so distinct on 2-D X-ray or lack of experience on immediate implant, particularly for multi-rooted teeth.  As time goes by, observation ability increases. The socket can provide the most precise 3-D image for surgeons.  Most of information is available if the brain and eyes are active.  Concentrate on every step of implant placement.  Give yourself ample time to finish surgery.  For example, every step of immediate implant can be remedied.  If a drill, osteotome and even implant is off, take it out and redirect it.  You are surprised to find that immediate implant has more flexibility than delayed implant.  The best of all, if immediate implant cannot be placed as planned, there is always a second chance.

Since peri implantitis in the molars appears more common than that of the premolars and anterior teeth, new protocols are proposed to reduce the incidence (2016_06_26).

Immediate Implant Molar Crown Materials for Bruxer

Xin Wei, DDS, PhD, MS 1st edition 01/21/2014, last revision 07/13/2020