Immediate placement upon extraction of 4: thoughts?

Last Updated: Jul 05, 2019

59 year old healthy female presented with fractured buccal aspect of tooth number 4. Wanted to “fill in other spaces mesial and distal to 4”. TP: ext 4 , immediate placement of 4, implant 5, bone graft, membrane, final restoration splint 4/5 together, distal cantilever. See xray sequence. Thoughts?

13 Comments on Immediate placement upon extraction of 4: thoughts?

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Alex Zavyalov

07/05/2019

Thoughts? You mean that a dentist did not have any restorative plan before tooth extraction and implants insertion?

peter

07/05/2019

Of course, Zavyalov, the dentist had a restorative plan - discussed possibilities with patient - did not want removeable and #2 is weak - se the xray and you'll understand

miguel

07/05/2019

looks as if you handled well. personally, i would have taken advantage of vertical height on 5 position and gone longer, however, is adequate.

DrG

07/05/2019

Why miquel? There are no studies to support use of any implant longer than 10mm.

miguel

07/05/2019

only my personal preference. the immediate implant on #4 has ~1/2 the implant in native bone w/ minimal amount of lift if any (good bicortical stabilization) Implant placed at 5 shows to be a more narrow implant. in my opinion, both implants were well placed. i agree with splinting, i just would have personally used a longer implant as the area placed would not allow a larger diameter implant. more bone to implant contact/surface. just what i would have done but very well placed, in my opinion.

Ed Dergosits DDS

07/05/2019

In the pre op radiograph there appeared to be good bone. What happened that resulted in the very large round radioluency?

Dr Gilani

07/05/2019

Large marginal defect at 4. possibly over-osteotomy while extracted. You were looking at vertical augmentation at 4. Observe carefully, if it was successful! Immediate placement post-extraction, I am not really a fan of, even without loading. Getting often post-op infection and complications. Make absolutely sure that bone grafting worked before loading.

Openwide11

07/06/2019

Can you post s Pano or FMX? Photos would be helpful as well to access quality of soft tiss. I’m not a fan of cantilevers and would have preferred a third implant. Good surgery. Nice work.

miguel

07/05/2019

would like to see ct. as ed notes, large diameter may have compromised residual buccal bone leading to future complications/bone loss. if extraction didn't go as planned (i attempt pet as often as possible) ct would ease those concerns though

Peter

07/05/2019

Thanks guys - all appreciated

DreamDDS

07/07/2019

Nice case. Comments valid. This is simple implantology approach when considering patients desires. Why cantilever 4. There is already wide diastema and probably thick gingiva. Patient can’t have it all if limiting the treatment. If treatment success you are brilliant , if it doesn’t , make the patient own it. Explain. Consent. Treat Sincerely Leonard

saul berkowitz

07/08/2019

Endo looks good on #4

Greg Kammeyer, DDS, MS, D

07/08/2019

I avoid distal cantilevers in partially edentulous cases.

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