Is an immediate implant possible in this region?

This patient presented with a vertical fracture in 25 and it is non-restorable. Is an immediate implant possible in 25 site?


22 thoughts on “Is an immediate implant possible in this region?

  1. Bruce A Smoler says:

    And don’t forget 3D evaluation to know with more certainty how much bone is available in space… An extended 20 yrs + (?) restoration should be able to wait a few months for a more predictable result…

  2. Charle krikorian says:

    What?-help me out here doctors. Where is the bone to engage post extraction? If he attempts to place it into palatal bone the angulation will be poor for restoring and function. The roots are not seperate and there is nothing beyond the apex but sinus?
    What’s the rush-graft and place post preservation.

  3. hedieh says:

    without primary stability, the implant will fail. So many things to consider before just saying yes to immediate implant, and you wont know until you extract the tooth, and see if you have four intact walls. Best tell the pt that you will likely have to graft and wait, unless the pt is very lucky and all stars align. Good luck.

  4. Alan Robinson says:

    A routine procedure; atraumatic extraction, small diameter implant (2.0X13mm) angled palatally through the approximate midpoint of the tooth socket palatal wall I-G, graft socket (RE-Oss), suture tissue, place composite temporary, 6 weeks healing time, impress for permanent restoration, evaluate ,adjust and cement permanent crown. A nearly everyday procedure. Good , predictable results and happy patients.

    • Dan says:

      Sorry, premolar. too small diameter.
      the transition from this implant diameter to
      the prosthetic tooth diameter is problematic
      for aesthetics and hygiene.
      why all this rush to immediate implants and grafts
      even when nature will do very well the job of the healing process
      by itself ?

  5. mark barr says:

    assuming from the insufficient xray details (cbct in this case due to sinus proximity )no
    it is not possible to immediately place an implant here. Two questions-where is the 3-4 mm of apical anchorage going to come from?
    where is the width available to place a wider implant that the tooth extracted – mesial distally its pretty tight to the adjacent teeth.
    Extract and graft properly and use a nembrane and suture well followed by glustitch. Go back 4 months later and use a Versah drill technique to implode the sinus 3-4 mm and now you can get your 3.5 or 4 mm by 8 or 10 mm deep implant in there and it will work.

  6. Daniel Song says:

    Yes, with 3-D evaluation of available bone and restorative outcome. A traumatic extraction and implant system selection for initial stability.

  7. Ed Dergosits D.D.S. says:

    Non restorable? I would treat this tooth routinely with endodontic treatment and a crown . If you decide to remove the tooth it could be restored with an immediate implant almost always.

  8. Nehal Sheth says:

    Yes it can be done with lateral engagement by little use of linderman drill and follow soft bone osteotomy protocol for all active implant . Remaing lateral space can be managed by jumping distance protocol.

  9. Alan Robinson says:

    First, 25 is a bicuspid,#13 in US numbering, so yes 1 Implant is sufficient. The Implant I referenced is a 2.0X13mm MDL by Intralock, a one piece implant. I do the procedure described multiple times per day and have hundreds of sucessful restorations, as do many other colleagues, so the debate about whether it can work has been settled years ago. Technique can be learned through Shatkin First, Amherst, NY or the International Academy of Mini Dental Implants (IAMDI). The future already arrived. Alan Robinson DDS MAGD FADI DICOI DIAMDI

  10. Chris W says:

    Not as easy as it might seem. Without the skills and experience your implant will end up touching the adjacent root . Perhaps it can be done ( we have limited info to make that call ) but should it be done in your hands. That’s the question we need to face everyday

  11. ST says:

    3d image, if all bony walls intact, atraumatic extraction, any 3.5 or 4 mm by 10 or 11-11.5 mm fixture will be more than sufficient. If you achieve decent primary stability, by engaging floor of sinus or even some manipulation, graft all voids, mobilise soft tissue, suture well to prevent encapsulation, place a Maryland temp and wait 4-6 months. If you want, do a drilling guide for best possible prosthetic outcome.

    It works well every time, done hundreds. Yes we could be “traditional” in our approach but at the end of the day the patient would need two surgical procedures and increased cost. As Alan Robinson very well said, “the future already arrived” embrace it.



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