Dentaltown May 2021 - 48

Fig. 7a

Fig. 8a

Fig. 8b

In fact, if you are in trabecular bone,
you can prepare the osteotomy just enough
to fit the apex of the implant into it. Then
use quite a bit of force to tighten it down, as
studies show you can go upwards of 170Ncm
with no detriment so long as you are safely
with in medullary bone. In comparison to
cortical bone, medullary bone is much more
vascular and able to remodel in response to
compression.9
In Figs. 7a-7d, you can see that the tooth
was removed and the implant inserted to
approximately 3mm below the estimated
gingival margin. This will help maintain
as much of the papilla as possible in the
interproximal of either side.10
Allograft was placed along the buccal gap
and the mesial where the extraction trough
was made. The graft was placed not only
in the gap but also above the bone on the
buccal, to add volume to the soft tissue as
it heals.11,12 Then a piece of PRF membrane
was placed over the implant and a healing
cap placed through it, creating a poncho
effect. The fibrin membrane is thus held
in place by the healing collar and covers
the entire socket further, helping keep the
graft in place. Sutures are then positioned
using a mattress technique to firmly affix
the gingiva against the collar.
Because infection is always of some
concern, adding PRF/PRP to the graft
and surgery site provides an added level
of protection, as well as improved softand hard-tissue healing.13 There are many

Fig. 7c

Fig. 7b

Fig. 7d

Fig. 8c

differing opinions on antibiotic protocols,
ranging from none to just a prophylactic
dose, as well as perioperative protocols. This
decision is case-dependent and multifactorial;
no single recommendation would be the
right one for every single patient.14

Postoperative return
A postoperative cone beam image was
taken to confirm the placement, with an
intraoral photograph about 10 days later.
Figs. 8a-8c show the implant was placed as
planned, with minimal angular complications
given the straight nature of the bone. The
soft tissue on the buccal is pink and firm
with visible thickness.

Conclusion
Immediate implants are a viable part
of a thriving implant practice, especially in
American culture, which values expediency.
The viability comes in the success rates
achieved when performed correctly by the
practitioner. Given that all doctors must
progress from beginner to expert, I hope
I have provided some good strategies for
success, as well as made the case that the
mandibular first premolar is a great starting
point for doctors to expand their skill set. n
References
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10.1097/ID.0b013e318166cb84. PMID: 18332764.
2. Blaine M. Cleghorn, William H. Christie, Cecilia C.S.
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