5 Months after Extraction: Place Implant Now or Wait Longer?

I have treatment planned this patient for a 3.75×13 implant in the 35 site which was extracted 5 months ago.  What is your opinion of the bone density in the radiolucent area?  Should I wait a couple of months before implant placement?  Should I place the implant now and hope that after 6 months when the implant is uncovered the bone will be have matured?  I will place the implant 2-3mm apical to the cemento-enamel junction of the adjacent teeth.  Do you think of the implant length and the implant-crown ratio will be acceptable?

16 thoughts on: 5 Months after Extraction: Place Implant Now or Wait Longer?

  1. Paul says:

    My hope is that we always take into consideration not only length of implant but also the diameter. A greater surface area of the implant means better retention and lesser vulnerability to detrimental forces. My recommendation is similar to a geologist. Before one is to build a structure, one should do a core sample and determine the environment the structure will be submerged into. If you, for example, can sink a perio probe into the healing area where you plan to place the implant and encounter resistance to your satisfaction, that should imply that the bone is ready to accept the implant. Unfortunately, as of now, by my knowledge, there are no exact standards set as to a precise test to establish bone readiness for implant acceptance. One needs to make subjective determination based on a reasonable test I described (for example) and deal with the consequences in a responsible manner. To go one step further one could obtain a core sample with a trephine bur and presented to a pathologist for microscopic evaluation. I doubt if that is ever practiced.

  2. Dr. JL says:

    It appears that the bone is not healing normally. The area should be more dense at 5 months. You can wait longer or be proactive and bone graft the socket. Hate to point out other stuff, but what about those periapical black halos on the adjacent molar.

  3. ST says:

    1 seems as if you have a large defect,
    2 doesn’t look like you have enough bone for even 10 mm, let alone 13
    3 even if you get a fixture in there, it will be a lot lower/deeper than adjacent teeth, it will not look and may be diff to clean
    5 have you treated lower left 6 (#36)?

    The most likely solution is a graft or a shorter fixture, but the later would need to be a lot wider, e.g. 5 x 8.5 ?

  4. Merlin P. Ohmer, DDS, MAGD says:

    Did you debride the site and graft? If so, what material?
    Also, in my opinion, there is way too much disease in that patent’s mouth to be concerned about an implant now.

  5. andrew says:

    In my humble opinion, bone has healed very adequately here and I would be comfortable to place a 3.75 x 13mm here (make sure you keep 2mm clearance from the mental foramen). It should be a straightforward case with straight forward direct-to-fixture screw access crown.

  6. Author says:

    There was external resorbtion on the tooth 35 before extraction. I didn’t use graft.
    There is no signs of inflammation around intraorally.
    Thank you for your thoughts.

    • CRS says:

      It did not work there is still a localized osteomyelitis there, refer it to someone who can regraft it properly. I see this a lot and fix it with appropriate materials and technique. The original infection was not treated at extraction that’s the typical result I’ve seen.

  7. Surgeon gardener says:

    I agree with Andrew, this case is probably ready to go. A 3D volume rendering can be deceiving. Use it as a reference, not for planning. My conebeam will let me see relative bone density. It’s not as exact as a bone sample, but it’s a good use of the tool and doesn’t involve an additional surgery.

  8. Mark says:

    Based on the imaging it looks like the implant/abutment would be level with the apices of the adjacent teeth. Compromised situation.

  9. Paul says:

    Mark, there is a possibility that you are misinterpreting the scan. My feeling that the two scans we see are taken before and after. The dates are the same but I am not sure if these dates represent when the scan was done. The outline of the grafted area could be there for another six month, a year but that does not mean that one cannot place the implants if the test shows solid bone. We place implants into socket of freshly extracted teeth and achieve primary stability by engaging solid bone and the scan looks worst than the one presented. It would have been nice to see a cross section but even than the picture may represent something different. A solid poke with a perio probe will be a fair indication of what the area represents. To be or not to be can easily be answered without a drama. One has to consider the fact that behind that picture is a person who may have some input as well. The person may decide to wait another six months or move forward if the odds are in favor of the implant surviving. These scenarios happen all the time.

  10. GIrish Bharadwaj says:

    Accepting that caries and endo situation is stabilised , perio seems to be a signifucant issue here .
    If perio was addressed pre treatment we could have grafted the area to gain better relationship of hard and soft tissue .
    Nothing lost yet.
    Augmentation is probably better at this stage considering vertical bone loss . Then proceed with implant in few months .
    We all learn from our past . It would be helpful to discuss such cases with a mentor before you embark on longer term plans .

  11. Merlin P. Ohmer, DDS, MAGD says:

    As the the original provider indicated, the tooth undergoing resorption, there was no debridement and no graft. Also, using limited radiographs, there appear to be much more urgent needs than the placement of an implant. No one died from titanium deficiency, but people have died because of active, rampant dental disease.

  12. Stefan Gollwitzer says:

    please first give treatment to apices of 36 , first lower left molar, otherwise all you do beforehand will or may be a planning failure concerning next steps . you may inspect the area and decide while wreatment of 36 intraoperative for a Augmentation regio 35, wait again for healing and then implant in regio 35 site, thank you regards

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