Case Study: Immediate Molar Replacement

Immediate Molar Replacement

Introduction:
The utilization of dental implants as a viable treatment option for the management of missing teeth has proved to be a successful and predictable option. (1) The original protocol proposed by Branemark (2) involved the placement of an implant in an edentulous area after adequate healing following tooth loss. The placed implant should be submerged and covered for periods ranging between six to eight months to allow for adequate healing without any exposure to the oral environment to prevent infection and provide better primary stability. Following the healing period, a second surgical procedure is performed to uncover the implant and allow for its prosthetic rehabilitation.
Based on the success of the

(13-15) Another back fall of this approach is the inability to achieve primary closure due to lack of enough soft tissue specially with thin biotypes, (16) which may result in flap dehiscence specially when guided bone regeneration techniques are employed in conjunction with the implant placement. (17-19) There is also a high probability of incorrect implant positioning in an occluso-apical orientation due to lack of ideal visibility of the vertical endpoint of the implant in the extraction socket resulting in either too shallow or too deep placement. (20) Finally, there is an inability to properly manipulate the surrounding soft tissue to ensure the adequate volume of keratinized mucosa around the implant.

An implant may be placed after a healing period of six months at least to ensure graft remodelling. This approach adds a little advantage over the previous one that the amount of bone loss due to socket remodelling may be reduced. But it should be notes that the resulting ridge anatomy and quality may be non-ideal and unpredictable.
3. Tooth extraction and socket grafting with flap reflection and barrier membrane:
This approach includes full thickness flap reflection and the use of a barrier membrane to protect the graft material. An implant could be placed after a period of at least six months. This treatment option is most beneficial specially when the buccal plate of bone is damaged or missing, therefore the ridge could be built up to the ideal dimensions and form for proper implant placement. Among the drawbacks of this approach is the possible loss of an intact buccal plate due to the remodelling associated with flap reflection and also the loss of keratinized mucosa specially in patients demonstrating thin biotypes.
4. Tooth extraction and immediate placement of two implants (two-implant supported