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Insta Pic: Immediate Placement

Hey Everyone!

Recently, I’ve been hearing some intense debates over immediate loading vs. delayed loading protocols. There are compelling arguments for each side. There is also substantial literature that can support either view, so it can be confusing when you’re considering adding this treatment to your repertoire.

Here are some case pictures showing immediate placement for a molar and immediate provisionalization for a lateral incisor along with some step-by-step commentary by Dr. Stephen Park.

#Immediateplacement of lower first and second molar 1.Fractured first molar and second molar with apical lesion 2. tough extraction for the first molar. Again arrow showing initial drilling through the fractured tooth 3. Socket after finial drill and removal of root. Notice on the mesial of the first molar had a small root tip with gutta purcha still in it. I managed to remove it. 4. #Implant placed (story continues with what actaully happened) I wanted to talk little bit about planning and what happens when I place these 5. arrow pointing to proposed implant site. Because of the shape of the second molar we plan to place more mesial. For the first molar I was aiming for the mesial root and the apical bone. 6. the second molar site was easy to place with great initial stability but for the first molar site I had trouble getting initial stability with 5.5 mm implant and when I got initial stability it was too low compare to the other. 7. changed out the implant to a 6.0 mm and I was able to get initial stability at the level I wanted for the first molar. Again Initial stability of a immediate placement of a molar is mostly through apical bone in most case.(I will share a case where I will get initial stability because of spetal bone) I hope this helps #implants #implantguru #implant_guru #implantsurgery #implantdentisty #dentalimplant #osseointegration #advancedoralrehabilitation #치아이식 #임플란트 #dentalphotography #dentalsurgery #prosthodontics #prosthodontist #dentisimplant #onephotolecture

A photo posted by Dr. Steven Park DDS MS (@implantguru) on

#immediateloading #immediateplacement of a lateral. If you want to try this select a case with lower esthetic demand as this case was. Remove the tooth carefully and place the implant engaging the palatal bone. I always try to get a screw temporary but for this case slop of the ridge required a cementable temporary. I always have some milled abutments around from other cases and I used it here. Essentially from now on this case becomes a regular crown we are temporizing. Prefab crown is used to reline and trim to customize. Under contouring the gingival portion is the key. Remember that these abutments have natural shape to help in that. Cemented with very little cement and make sure to remove all excess. Really wanted to show a screw temporary but have found a case to show the steps yet. Thanks for viewing. #implant #implants #implantguru #implant_guru #implantdentistry #advancedoralrehabilitation #osseointegration #dentalsurgery #dentalimplant #dentalphotography #hiossenimplants #cosmeticdentist #cosmeticdentistry #estheticdentistry #aestheticdentistry #surgicalprosth #surgicalprosthodontics #surgicalprosthodontist #prosthodontistrule #prosthodontist #prosthodontics #onlyprosthodontist #치아이식 #임플란트

A photo posted by Dr. Steven Park DDS MS (@implantguru) on

The decision tree for immediate placement and loading is complex and the procedure can be highly technique sensitive. If there is sufficient interest in this (from you), I’ll begin a thread explaining the technique in detail.

  • Are you immediately placing implants at your office?
  • Any experiences to share with us?
  • Is this something you’d be interested in learning more about?

Let me know by dropping a comment!

Subscribe to stay tuned and have a great day!

Cheers!

Ivan

2 thoughts on “Insta Pic: Immediate Placement

  1. A decision tree would be great!

    My first multiple immediate implant case was in a bridge space. #29-31. #31 failed and needed extraction and #29 was fine. Placed two implants with success. The implant that was immediate into #31 space, I did not get great stability around 20 Ncm. Decided to leave it and see how it would heal based on the experiences of a surgeon who taught a class I took earlier in the year. The other implant got around 30 Ncm. In the end, got great stability and healing. I use ISQ readings to test 3 months after placement and the readings were 75+ for both readings.
    The issue was I ended up placing the implants too close together. I was more focused on finding the right place to put the implants to get the best stability, and I failed to take into account the end result. Crowns were still restored but with difficulty, and one had to be cement-retained which I always try to avoid when planning the implant placement.

    Learned a lot from that case.

    1. Thanks for the comment Craig! A decision tree is in the works!

      One of the biggest issues with immediately placed implants is that the bony platform on which you are trying to place your implant is limited. This can very often lead to poorly oriented implants for the sake of engaging bone. Sometimes, for immediately placed posterior teeth that have low primary stability, I sink them and place a cover screw so that the patient is not tempted to bite down hard on them and introduce the malicious micromotion that can lead to failure. It sounds like you learned a lot from your, “oh crap” moment.Thanks for sharing!

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