Crest Preservation with Immediate Implant Placement

This patient presented with poor prognosis for the remaining teeth and 2 implants.  In the mandible, the treatment plan was to extract all the existing lower teeth, removing the 2 failed implants 45,46 (29,30), while keeping implant 33 (22) in place. Thereafter, the plan was to perform immediate implant placement of 3 implants and simultaneously augment and preserve the ridge crest. The final prosthetic plan was to provide the patient an implant overdentures on the implants.

After extraction and complete debridement,  the implants (DMI Technologies Ltd.) were placed submerged, by one millimeter below the crest with good primary stability.  The flap was raised, the release being be as minimal as required in order to have moderate tension during the closure, but not tension free. Hard tissue was prepared.  Thereafter, Augma’s Bond Apatite Cement was used to augment the crest.  After activation of the cement within its syringe, it was delivered directly from the syringe above the implants and above the crest and slightly overfilled. Thereafter, pressed for 3 seconds using a dry gauze pad above. ( An instrument should not be used to push the cement between the implant and the socket walls.)

Following the placement of the cement, soft tissue closure occurred. The cement was covered directly by the flap and no membrane was used. The flap was sutured in place with moderate tension. (It is important, when using, Bond Apatite Cement, that the soft tissue closure should not be tension free as with conventional augmentation techniques ).  The soft tissue should be closed maximally without leaving more than more than 1-3mm of cement exposed.

In the 3 Months Post Op, healing was uneventful and re-entry took place after 12 weeks.  During re-entry a diamond bur was used to remove excess bone grown above the cover screws.  Integration of the implants was achieved and ball attachments were connected to the implants.

Surgery Performed by Dr. Ilia Mushayev DMD

4 thoughts on “Crest Preservation with Immediate Implant Placement

  1. Dr. Rayment says:

    Interesting case. It is odd that the panoramic image does not match the clinical (3 implants in the mandible v 4). I’m sure you had to flatten the ridge to place some of the implants and also to create restorative space, however it appears that there is almost no alveolar bone left. Comparison of the image with teeth versus post extraction and grafting shows a ridge now at close to the floor of the mouth. Finally, if you do have to remove alveolar bone to flatten the arch and create restorative space, why would you need to graft bone in this area?

    • dr amos yahav says:

      Dr.Raymant thank you for your comment ,however if you will pay good attention at the panoramic you can see that the fogginess on the panoramic masked the “missed” implant .in addition no crest shaving was done . panoramic image can not be compared since they are two dimensional especially if they where taken with different angels .
      see the remaining implants(22) that was not removed in both panoramic and its position in the bone which will reflect perfectly why it is wrong to have any conclusion based on panoramic . CBCT is a different issue .

  2. greg steiner says:

    It appears the ridge was removed rather than preserved. If Bond Apatite is an effective bone graft why didn’t you do a lateral augmentation to gain width. This way you would have a ridge for your overdenture which would be much more stable. If these implants don’t perform any better than the previous ones this patient is left with no ridge.

    • dr amos yahav says:

      there is absolutely not need for lateral augmentation in this case the crest is sufficiently wide ,and definitely the ridge was not removed . as i mention in my previous comment .please it is wrong to compare two panoramic. see the remaining implants(22) that was not removed in both panoramic and its position in the bone which will reflect perfectly why it is wrong to have any conclusion based on panoramic . CBCT is a different issue .

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