Immediate implantation in alveolar socket of extracted molar in mandibular

Alexander Kobyakov
Dental, oral and maxillofacial surgeon
Place of work: Regional Hospital named N.I. Pirogov, Department of Maxillofacial Surgery
Implantation Experience: 4 years

Immediate implantation in alveolar socket of extracted molar in mandibular

(Case report)

Immediate implantation attracts more and more dental specialists every Year since it provides quick patient`s rehabilitation and most aesthetic and functional result in as soon as possible. In addition, recent researches shows that dispite peri-apical focus of chronical inflammation and contamination of alveolar socket with microorganisms, the rate of successful implantations is still high and is almost as for two-stage protocol. (Alphonse Gargiulo, et al., 2011; Binbin Yu et al, 2015). In addition, it should be emphasized that immediate implantation protocol, while observing, save maximum of border tissue anatomy and to achieve required aesthetic and functional index during patient`s rehabilitation after teeth extraction(V. Kolte, 2013).
However, the concept of “immediate implantation” for alveolar sockets of upper and lower jaws require different strategy and methods, in particular for morals alveolus in the mandible. Successful implantation requires further conditions:
• Presence of midradicular wall with wide floor;
• The distance between socket floor and inferior dental canal more than 4 mm. (with the 3 mm. required for implant immersion lower that cementoenamel junction of adjacent tooth);
• Active implant (in order to obtain stability in molar socket);
• Possibility to save more than 1,5 mm. of bone tissue around the implant in correlation to adjacent anatomical formations ( root of adjacent tooth, nerve channel, adjacent tooth alveolar socket ).
In should be noticed that technique of implant placement in mandible molar socked foresee its fixation in the interradicular septa and socket floor of extracted tooth (Pic. 1), with further space filling with osteoplactic material. After this stage the gap should be covered with collagen membrane or without it according to specialist`s thoughts.

Pic. 1 Scheme of implant placement in socket of extracted tooth in the mandible.
(«Implant Dentistry at a Glance». Jacques Malet, Francis Mora, Philippe Bouchard, 2012)

Clinical case

Patient P. 30 years old, came to the dental clinic complaining to damage tooth in the mandible. Previously this tooth experienced numerous endodontic treatments.
After examination the dentist found that 3.6 tooth is damaged to the gingiva margin with caries and it`s root are detach. The tooth was non-movable, performed no reaction to the temperature and mechanical manipulation with no changes in adhere mucosa of alveolar bone.
Diacrisis “chonical periodontitis of 3.6 tooth ”

According to CBCT tomography results the diacrisis was proved and the dentist created the plan of further implantation surgery (Pic. 2).

Pic 2. Planed position of implant included anatomical peculiarities of 3.6 tooth socket.
In order to obtain enough initial stability, the dentist choose active implants Bio3 Progressive 4.2/11.5.


Surgery protocol: under local anesthesia with Ubestezine 4% - 1,7 ml and after antiseptic skin and mucosa treatment, dentist separated roots of 3.6 tooth with spherical dental cutter (Pic. 3). Tooth roots were extracted. Then the dentist made operative exploration and curettment of socket walls and washed them with sodium chlorine solution 0,9% (Pic 4-5). The dentist made osteotomy in the area of interradicular septa to its floor and expended osteotomy zone that it will fit the last drill (Pic. 6). Then the dentist made enlargement X-ray of tooth socket with drill in osteotomy area in order to check further implant position (Pic. 7). Then the dentist made final osteotomy and placed Progressive 4.2/11.5 implant (Pic. 8). Implant was fixed in implant bed with 35Н/сm2 load. The gap between implant and alveolar walls was filled with bone (Pic. 9). The socket was covered with free gingival graft from maxillary tuber in order to save implant and material in socket and to create massive of attached keratinized mucosa (Pic. 10.-13). Then the dentist made controlling enlargement X-ray of placed implant (Pic. 14).

 Pic. 3. Separation of 3.6 tooth roots
 Pic. 4. The view of separated 3.6 tooth roots
 Pic. 5. Tooth root extraction from 3.6 tooth socket.
 Pic. 6. The view of osteotomy of interradicular septa
 Pic. 7. The position of drill in zone of osteotomy in 3.6 socket walls.
 Pic. 8. The view of placed implant Progressive 4.2/11.5
 Pic. 9. The gap between implant and tooth socket filled with bone
 Pic. 10. Free gingival graft tissue recovery from maxillary tuber
 Pic. 11. Deepithelialization of free gingival graft
 Pic. 12. The view of deepithelialized free gingival graft
 Pic. 13. The view of a wound after surgery. The graft is sutured to the socket edges.
 Pic. 14. Controlling enlargement X-ray of placed implant in the area of 3.6 tooth socket: the view of Bio3 Progressive 4.2/11.5 implant.