Which is better: implantation first or extract first?
I have treatment planned this patient for extraction #15 and 18 and crown on #20 and implant in #19 site followed by a crown. In terms of treatment sequence, should I extract #15 and 18 first, and then place #19? Or should I first place #19 implant and then later extract #18? I have heard that this may conserve bone around the implant. On the other hand, I am concerned that the extraction of #18 may damage the bone around #19 site because this patient has very dense bone and the extraction may be difficult. I am also concerned that if I place the implant first, I may damage the implant when I extract #18. What do you recommend?
11 Comments on Which is better: implantation first or extract first?
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CRS
2/19/2016
I would keep 18 to protect the implant from the forces of occlusion it also serves as a spacer to hold the vertical dimension. I don't think this tooth will be difficult to remove atraumatically. I would keep 15 too. The teeth help you line up the implant. Otherwise remove both and make a surgical guide for the free ended implant site. I remove teeth if I am concerned with infection.
peterFairbairn
2/19/2016
Great comment CRS all in there .
Peter
greg steiner
2/19/2016
Either option will work but I would choose neither option. I would remove the molars and place the implant at the same appointment. One surgery and done. Section #18 and take out the roots atraumatically and then open the flap and place the implant. Greg Steiner Steiner Biotechnology
Dr. T
2/19/2016
No rush to remove #15 and #18 unless there's infection. Section the roots of #19 after you have restored #19. Shouldn't be a problem. If you are really worried about the EXT then refer to OS.
Alex Zavyalov
2/20/2016
There is rather stable occlusion here. I would do extraction first. Unilateral rehabilitation with a single implant may lead not only to the implant overloading, but also to a possible TMJ disorder because the patient will chew mostly on the working left side.
Daniel Camm
2/23/2016
I agree with Greg Steiner. Why would you do two surgeries on the patient? I do this all the time. It works fine. Every time.
Dan Camm
Dr Gilani
2/23/2016
15 is a bacterial heaven mesially, thus taxing immune system. Extract it anyway.
18 is functional with little furcation involvement. I would crown it and keep it as long it lasts without infection. It occludes also 1/3 with 14.
Gregori Kurtzman, DDS, MA
2/23/2016
18 has an area on the apical of the distal root and with the furca issue its not a good candidate to try and keep I would extract it split it in two down the furca and extract it and place the implant at 19 at same appointment. why do two surgeries?
Eric Katch
2/24/2016
I'd create the implant osteotomy first, can use 18 as a "guide". Remove 15, and 18 atraumatically, and consider bone graft these sites. Then place implant in 19 site. Place implant last so I could modify the site if something unusual would have happened in delivery of 18. All in one visit.
mpedds
2/25/2016
This patient has no posterior molar contact. Consequently all occlusal load is on the premolars, and look at # 20,21! Remember that these molars provide valuable proprioreception to the patient to prevent slamming down on an implant. I would recommend placing the implant at the #19 site and then while letting it integrate restore the remaining dentition, especially the right side to a stable occlusion. Retaining #18 is just a professional choice. I agree with the previous post that it looks like it has some contact. It may be prudent to restore it. Should you decide to remove it, I would section it first.
Amit Binderman
2/25/2016
Another option or benefit to consider is to use the extracted tooth as dentin-bone graft for the implant procedure that follows as well as for any remaining bone defects or socket preservation that you might need. I'm obviously referring to the KometaBio protocol for converting an extracted tooth into autogenous dentin-bone graft while the patient is on the chair. If you have the tooth, why not use it as an excellent cortical-like bone graft.
