Posterior Single Immediate Dental Implants Placement

Our previous blog discussed the management of an anterior (front) tooth with an Immediate Anterior Dental Implant placement with Temporization (temporary crown is placed on top of the implant on the same day of surgery). It is well established in our literature that this is a valid treatment protocol for clinicians with experience and training.  

This treatment protocol can be applied to posterior (back) teeth as well, but without an immediate temporary due to the bite forces, which can interfere with the normal healing process of the implant.1,2

Our back teeth are important in that they allow us to chew our food in order to maintain a healthy diet. Most of our bite forces are created when our teeth contact during eating and swallowing and these forces are transferred to our teeth. You think of our back teeth like a fulcrum, which is very similar to a nutcracker tool. The teeth closest to the fulcrum arm will generate more force compared to the teeth away from the fulcrum arm.  

As we age, our teeth will wear and tear.  Due to the wear and tear, our teeth can develop cracks. Continuing with the above analogy, our lower second molars exhibit the greatest amount of bite force and these teeth are most frequently associated with cracks. 3 Cracks can come from injury to the tooth and or large fillings that weaken the surrounding portion of the tooth. Cracks can be microscopic and may not be visible to the naked eye or they may located in the root portion of the tooth and are undetectable.  

As a result of the crack, the bacteria can enter into the tooth, causing decay or infection damaging the tooth.  Sometimes a tooth can be saved with a crown and or with a root canal therapy. When a tooth can’t be saved because it is non-restorable, an immediate molar implant protocol can be utilized.

TREATMENT PROTOCOL

A detailed examination with a dental CT-Scan is obtained to 3-dimensionally analyze the surrounding anatomy of the region of interest to avoid injury to critical structures (nerves, sinuses) and to evaluate the existing anatomy of the tooth to be removed. Additionally, an intra- oral digital scan of your teeth can be taken and data from both an intra-oral scan and a CT scan can be merged with 3-dimensional treatment planning software. This data can be used to virtually place an implant and create a surgical guide which can increase the accuracy and precision of the implant surgery. However, this technology does not replace the experience and clinical skills of the clinician and must be verified for accuracy during the procedure.

Figure 1: Root caries formation along the side of upper tooth. Image from Compend Contin Educ Dent 2020 Jan;41(1)

A recent article reported that wider diameter implants (implants with widths greater than 5.0 mm) used to replace molar teeth can be advantageous in preventing the formation of root caries (cavities that forms along the sides of the teeth).4 There may be an increased risk of root caries formation on a posterior tooth that is next to an implant (Figure 1).

Figure 2: Horizontal distance from the implant platform/abutment connection to the adjacent tooth: Image from Compend Contin Educ Dent 2020 Jan;41(1)

One explanation is because the diameter of an implant typically is smaller than that of the tooth being replaced, and the circular shape of the implant does not replicate the normal anatomy of the tooth, a large space between the gum area between the implant platform and adjacent tooth often results. As a result, a common reported finding from patients who have posterior implants next to teeth are “food getting caught between their implant crowns.” By using a wider diameter implant, there is less horizontal spacing between an implant an a natural tooth, and this could decrease the rate of caries formation (Figure 2).

CASE REPORT

The extraction of a posterior tooth and the placement of an immediate implant can be  minimally invasive. This is accomplished by carefully and atraumatically removing the tooth, preserving the surrounding bone and not manipulating the gum tissues. This preserves the surrounding bone and blood supply, which minimize the pain and swelling after the procedure. Over the counter pain medications can be taken to manage the mild discomfort and patients can go to work the same or following day with minimal changes to their daily schedule.

The case below illustrates an actual patient that was successfully treated at our practice. It will highlight the specific use a of a wider diameter implant for the replacement of a molar tooth.

SUMMARY

If you are faced with a decision to replace your back tooth, refer to this article and ask questions about your treatment with your provider.  We at PDG are specialists who routinely manage these types of cases and we welcome an opportunity to serve you.

Information about the AuthorDr. Tassos Sfondouris is a board certified periodontist and restorative dentist. He is a clinical research associate at NIH. He is passionate about periodontal and restorative therapies that promote the health, comfort, and function of teeth. He welcomes your comments and encourages you to like him on Facebook or follow him on Twitter to get the latest unbiased information on pertinent dental health topics.

REFERENCES

  1. Kan JYK, Rungcharasseng K, Deflorian M, Weinstein T, Wang HL, TestoriT. Immediate Implant Placement and Provisionalization of maxillary anterior single implants. Periodontolo 2000. 2018 Jun: 77 (1): 197-212.
  2. Pagni G, Pellegrini G, Giannoble W, Rasperini G. Post Extraction Alveolar Ridge Preservation: Biological Basis and Treatment; Int J Dent 2012; 2012
  3. Yang SE, Jo AR, Lee HJ, Kim SY. Analysis of the characteristics of cracked teeth and evaluation of pulp status according to periodontal probing depth. BMC oral health. 2017 Nov 28; 17(1):135.
  4. Smith RB, Rawdin SB, Kagan V. Influence of Implant-Tooth Proximity on Incidence of Caries in Teeth Adjacent to Implants in Molar Sites:A Retrospective Radiographic Analysis of 300 Consecutive Implants. Compend Contin Educ Dent 2020 Jan;41(1)

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