J Korean Assoc Oral Maxillofac Surg.  2023 Feb;49(1):30-42. 10.5125/jkaoms.2023.49.1.30.

Guidance and rationale for the immediate implant placement in the maxillary molar

• Mustakim KR
• Eo MY
• Lee JY
• Myoung H
• Seo MH
• Kim SM

• KMID: 2539702
• DOI: http://doi.org/10.5125/jkaoms.2023.49.1.30

Abstract

Objectives
While the reliability of immediate implant placement in the maxillary molar has been discussed, its significance is questionable. There have been no guidelines for case selection and surgical technique for successful treatment outcomes of immediate maxillary molar implants. Therefore, in this study, we classified alveolar bone height and socket morphology of the maxillary molar to establish guidelines for immediate implant placement.
Materials and Methods
From 2011 to 2019, we retrospectively analyzed 106 patients with 148 immediate implants at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. Inclusion and exclusion criteria were applied, and patient characteristics and treatment results were evaluated clinically and radiologically.
Results
A total of 29 tapered, sand-blasted, large-grit, and acid-etched (SLA) surfaces of implants were placed in 26 patients. The mean patient age was 64.88 years. Two implants failed and were reinstalled, resulting in a 93.10% survival rate. Fluctuating marginal bone level changes indicating bone regeneration and bone loss were observed in the first year following installation and remained stable after one year of prosthesis loading, with an average bone loss of 0.01±0.01 mm on the distal side and 0.03±0.03 mm on the mesial side.
Conclusion
This clinical study demonstrated the significance of immediate implant placement in maxillary molars as a reliable treatment with a high survival rate using tapered SLA implants. With an accurate approach to immediate implantation, surgical intervention and treatment time can be reduced, resulting in patient satisfaction and comfort.

Keyword

Bone graft; Immediate implant; Maxillary molar; Socket lifting; Tapered implant

Figure

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  Fig. 1 Classification of alveolar bone height (ABH) and interradicular septum. A. ABH Grade A. B. ABH Grade B. C. ABH Grade C. D. Type I interradicular septum. E. Type II interradicular septum. F. Type III interradicular septum.

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  Fig. 2 Representative case of Grade A Type I. A, E. Pre-installation views. Panoramic radiograph shows the distance of the roots to the maxillary sinus floor (blue arrow; A), indicating alveolar bone height Grade A (A) and clinical view of a Type I socket (red arrows; E), radiographic (B) and clinical post-installation views of implant in a Grade A Type I socket (red arrows; F). B, F. Post-installation views. C, G. Re-entry views. D, H. Most recent follow-up following prosthesis delivery.

• 

  Fig. 3 A case with immediate placement of two maxillary molar implants. A, D. The pre-extraction panoramic (A) and clinical views (D), the panoramic view showed characteristics of Grade A. E. The socket condition following #26 and #27 extraction showed characteristics of Type I in the first molar and of Type II in the second molar (red arrows). F. The 4.1 mm×10 mm Straumann implant fixtures (Institut Straumann AG) were installed. G. Clinical view after installation of the fixtures in the Type I and Type II sockets (red arrows). H. Bone graft proceeded following fixture installation (black arrows). B. The postoperative panoramic following implant installation. C. The panoramic view four months after implant installation showed no marginal bone loss or radiolucency surrounding the implant.

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  Fig. 4 Representative case of Grade B Type I. A, E. Pre-installation views. Radiographic view of decayed first maxillary molar (A) and clinical view of Type I socket after extraction (red arrows; E). B, F. Post-installation views show the proximity of the implant to the maxillary sinus, indicating alveolar bone height Grade B (blue arrow; B) and the implant inside the interradicular septum (red arrows; F). C, G. Re-entry views. D, H. Most recent follow-up following prosthesis delivery.

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  Fig. 5 A-D. Representative case of Grade C Type I (A-D) with red arrows indicating the interradicular septum and blue arrows indicating the alveolar bone height. Implant was placed following socket lifting (C). E-H. Re-installation without sinus lifting in a case of Grade C (blue arrows; E) Type I (red arrows; G) using a short, wide-diameter 5.0 mm×7 mm Luna implant. I-L. Representative case of reinstallation and sinus lifting of Grade C; blue arrows indicate the distance from implant to the sinus floor. I, J. The first installation using a 4.0 mm×7 mm Luna fixture. K. Re-installation using a 4.5 mm×7 mm Luna fixture together with sinus lifting. L. Most recent follow-up radiograph after prosthesis delivery showing the final prosthesis state and the newly formed bone post sinus lifting.

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  Fig. 6 Representative case of Grade A Type II. A. Preoperative radiograph shows failed endodontic treatment of the first maxillary molar. E, F. Type II socket filled with bone graft (black arrows; E) and covered with collagen membrane (yellow arrows; F). B. Post-installation radiograph. C, G. Re-entry views. D, H. Most recent follow-up following prosthesis delivery.

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  Fig. 7 Representative case of Grade A Type III. A, C. Preoperative views. D, E. Extraction socket shows Type III interradicular septum (red arrows; E). B, F, G, H. Implant installation using a wide-diameter 6.5 mm×8.5 mm Anyone fixture. B. Alveolar bone height indicating Grade A (blue arrow). G, H. The wide-diameter implant engaging the socket wall (red arrows; G).

Reference

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