Do I need to wait 1 month to do implant (#20) if I just extracted #19 atraumatically?

Hi The choice of placing an implant in site 20 can be done in a few weeks. In my opinion is not dependant on 19, and you could have done it at the same time as the extraction. However what is the bigger plan? a single tooth implant in the 20? What will be done with the 19 site in the future?

I see no reason to wait for implant placement on #20.

Waitnig 3 weeks for soft tissue closure can have benefits , then place whilst the ridge dimensions are still optimal. The best graft without a doubt is the IMPLANT! Regards Peter

The case description does not contain information why those teeth needed to be extracted. According to X-ray they were salvageable to avoid implant placement to make fixed partial. It seems to me it’s from everyday dilemma: “What is the best for patient and for dentist?”

Graft now and place the implants later.

I agree with Dr. S and Dr Jon Kong, I had the same case like yours ,I did implant first to control the position and after that I did extraction in the same time,so keep going

Never use a xenograft here!

go ahead and place the implant in 20if the width is ok , if not wait for soft tissue clossure and then implant and graft..... not placing one in 19? if so yes wait 3-4 weeks and place both together

Place it the same day. You're not restoring the implant. Or if 19 will also get the implant then wait to do both simultaneously

If you can not handle soft tissue properly, please wait a few weeks.

Wait 4 to 6 weeks then place both implants #19 ,#20 site .This will give you better control of size space utilization and well healed well formed soft tissue for stable sustainable soft tissue closure.Patient will go through less visits.

if you have the bucal palte place the implant

Hello Do wait for 3-4 weeks as this will give you better results. Best of luck

I would wait at least 6 months before placing both implants

Best results comes with optimal tissue healing, If you're not thinking about early loading of the implant why not to wait 2 - 3 more weeks? In this time you will have inicial bone maturation, Better for stability of the implant, and the software tissue will be in Better conditions to close the new installed implant. Why's the hurry so important at this time? Wait and surelly you will get Better results, and use a dental shaped acrilic guide to Better position the implants!

Why wouldn't you ask that question, before you removed the tooth? Bv

I did this same case, one week ago. The restorative doctor provided me with a guide and the implant was placed , at the mesial root of 19 and # 20. We removed an upper third molar and used that bone to graft the distal socket. This patient will be restored and functioning in less than three months. One surgery. When you place an implant in a molar sight, the chance of overheating the bone is significantly less. The majority of your osteotomy is done. It's in everyone's best interest to have a comprehensive tx plan, way before you start removing body parts. The modality, is a time tested, cost effective, means of treatment . Maybe the tooth was abscessed. I still can't wrap my brain around, removing a tooth and waiting 5-12 weeks. Bv

You have two separaate sites that need to be treated differently. #20 is virgin bone and therefore can be implanted immediately. #19 does not have enough bone superior to the nerve and therefore must heal 3-4 months before implantation. If you are planning implantation of #19 a socket bone graft at the time of #20 surgery is advisable. You could have placed #20 at the time of #19 extraction.

Now, how do you know how much bone is above the ia nerve . Maybe I wasn't privy to a ct scan, with nerve edits. I am communicating via I-phone, so maybe it was there and I didn't see it. You don't necessarily have to go lower than the apex of # 19. I have yet to run into a case, such as this where a 5mm implant wasn't significantly wider than the apical and middle third of the implant. So, my answer to the question is, place the implants at the time of extraction. You are going to have a hard time convincing me that cutting through three week old granulation tissue and colonized bacteria, makes more sense than placing the implants in a "clean", non friable, environment . Bv

Sorry, meant to say, wider than the apical or middle third of the socket. Bv

no you don't have to wait for #20 , but how about #19? let it heal 3 months go back and place #19/20 the same day. you don't have to graft every socket.. take a cbct is the standard of care for every implant case

Initial stability is my prime directive about implants. If you won't get it, wait six weeks to get some. Graft is not mandatory.

What is the plan for # 19? If #19 is also getting implant, graft now and place both (19 & 20) implants three to four month later.

I see two ways of planning a case like this: 1- Extraction of the teeth (never, but never use bone graft in site #19, there is no need. Your patient will spend money and you will have to wait more time to install the implant in this site. Let blood clot do its job.), wait 3 months and install both implants. Or 2- Extraction of the teeth and install the implant in site #20 in the same surgery and after 3 months install implant in site #19. Install of the implants ALWAYS with a surgical guide done after a proper planning of the case. Good luck.

Good surgery, but need plan prior. If the tooth isn't "hot", why not southern Max 7x9 or 8x9, designed specifically with this situation in mind. Awesome results in three months flat, place #20 at the same time, both with tissue training healing abuts and you restore in 3 months with ideal results, no second stage surgery! Talk about efficient. Diode laser manages minor flaws and this is a happy client! Of course, proper placement is essential always, ct guided or old school guided....

...Due to the product’s inability to resorb under normal conditions, themanufacturer instructs the doctors to pack the Bio-Oss very lightly in the sinus. This method will produce fibrous tissue encapsulation of the material. The reason for fibrous tissue encapsulation is the body’s defense mechanism, due to the materials’ negative mechanical and chemical properties; the body is trying to defend itself from this foreign material. The fibrous tissue results in a problem, as mentioned in a book by Ole T. Jensen, The Sinus Bone Graft, chapter 17 (Use of Xenografts for Sinus Augmentation by Stuart J. Froum, Stephen S.Wallace, Sang-Choon Cho, and Dennis P. Tarnow)....

Antonia, you are limiting your patient's options, big time, if you can't successfully place implants in a fresh extraction site. And yes, you do have to graft, in that situation . You do not have to get primary closure, with the appropriate membrane. I suggest using real bone, but it has been proven, time and again, that allografts work quite nicely . Bv

The main reason I suggested grafting the socket for # 19, is to form a better and safer site for the placement of an implant at # 19. One should have a greater chance of avoiding injury to the IAN. I suggest placing the implants (#19 & 20) later and at the same time for the sake of simplicity and again safety.

Dear Baker vinci, I am suprised about your statement. You mentioned that allgrafts work quite nicely. I can understand that bone from human cadaver is quite similar to the patients own bone. That makes scence. But it leads never a to a real living own bone because allografts are hydroxyapatits. If you examine allograft hydroxyapatite under the microscope you will find everytime the allograft hydroxyapatite. There is no resorption at all.

Dr A, I am a graft purist, from a good ways back, in that I will always believe autogenous bone is "the way to go". However, there are way too many people, a lot smarter than me, getting fantastic results with mineralized and Demineralized bone. I'll let you take that up with them. Bv

Dear Mike Stanley do you advocate some type of 3rd world old fashioned censorship , we are professionals and make decisions on behalf of our patients. Whilst like all Orthopaedic and Spinal surgeons I have never used a Xenograft it is a decision which I am entitled to make. Regards Peter

imediate implantation after xtrtn is or perhaps was the best choice as theory says and scientific data proves there is going to be a faster bone loss in the first year of xtrtn Oh dear the foremost advantage and use of implant is to preserve the bone so why wait(unless xtrtn was done for infetive reasons) whats done is done do not dis respect the soft tissue by burying implants within 3 weeks as you might be aware of the healing phase.Bone graft will jeoparadise treatment planning(unwarranted waiting period and more ....you know it) the whole world is ther to give suggestions read on and do the best Dr Ak

You have not written about the clinical conditions of premolar and last molar. To avoid patient's visits, (and earning) you could place direct implant in first molar region and could construct prosthesis including either premolar (caniliver type of bridge), or last molar (3 unit bridge). Later after 9 months or so if patient can afford or desire the implant could be placed for second molar too.

No. You could have placed the implant for #20 on the same day you extracted #19.