Where to Place Immediate Implant in this Lower Molar?
It would be ideal to place an immediate implant in the septum for the purpose of restoration. But for this case, since the mesial (Fig.5 M) socket has a large pathologic lesion (arrowheads), drills or osteotomes would avoidably slide into the weakest area (the mesial socket) if the osteotomy starts in the middle of the septum. Additionally, osteotomy into the periapical lesion should cause more discomfort and pain.
Therefore osteotomy will start on the strong side of the septum obliquely (for drill entry, Fig.6 red arrow). Once the drill gets entrance, change trajectory and the osteotomy will be 3 mm deeper than the original socket (Fig.7). The osteotomy will finally form between the septum and the distal socket.
Reamers will be used until 5 mm (save bone). Next use the smallest drill (4.8 mm) in UF Extra Wide Kit and 6 mm drill (for pre-implant conditioning/adaptation). Place 6.5 mm implant. If the torque is too high, remove the implant, use 6.5 mm drill and place the implant again.
Does this new protocol work? Is the implant placed where it is supposed to be?
Lower Molar Immediate Implant,
Xin Wei, DDS, PhD, MS 1st edition 03/25/2015, last revision 04/15/2015