Immediate placement upon extraction of 4: thoughts?
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?
New comments are currently closed for this post.
Alex Zavyalov
7/5/2019
Thoughts? You mean that a dentist did not have any restorative plan before tooth extraction and implants insertion?
peter
7/5/2019
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
7/5/2019
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
7/5/2019
Why miquel? There are no studies to support use of any implant longer than 10mm.
miguel
7/5/2019
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
7/5/2019
In the pre op radiograph there appeared to be good bone. What happened that resulted in the very large round radioluency?
Dr Gilani
7/5/2019
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
7/6/2019
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
7/5/2019
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
7/5/2019
Thanks guys - all appreciated
DreamDDS
7/7/2019
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
7/8/2019
Endo looks good on #4
Greg Kammeyer, DDS, MS, D
7/8/2019
I avoid distal cantilevers in partially edentulous cases.
