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Immediate loading of a molar, post-extraction

by: Ira Schecter

NobelActive – a solution for the restoration of both single- and multi-rooted teeth.

Here is a case study of implant placement immediately after a molar extraction using NobelActive in conjunction with immediate temporary loading.

This patient is a healthy, middleaged male with no medical preconditions and satisfactory oral hygiene.

Figure 1. Illustrates a lower left first molar that had a previous root canal treatment and was obviously failing. Retreatment endodontically was deemed to be unpredictable at best, and the treatment option selected was to extract the tooth and place an immediate dental implant into the socket site.

Figure 2. Illustrates how the tooth was extracted atraumatically, preserving as much of the surrounding bone as possible. We chose a Nobel- Active dental implant because its surgical protocol dictates minimal osteotomy preparation and thus allowed me to utilize the available inter- septal bone between the two root socket sites. The implant was submerged below the adjacent crestal bone heights and was totally engaged in host bone. No bone grafting was carried out in the adjacent sockets as we expected the sockets to fill-in via the natural host healing process.

The implant was torque challenged to greater than 50 Ncm and was tested for initial stability in the host bone utilizing an Osstell Mentor frequency resonator.

Figure 3. The implant passed all tests for initial biomechanical stability, and an impression was taken at the time of placement after suturing the tissue.

Figures 4. An immediate acrylic temporary restoration was made, which was secured to the implant and inserted 24 hours post-op.

Figures 5–7. The surrounding bone was allowed to heal for a period of six months and a new impression was taken to index the healed tissue around the temporary acrylic crown restoration. A custom NobelProcera Titanium Abutment was inserted and torqued to 35 Ncm and then an all ceramic NobelProcera Zirconia Crown restoration was cemented on top of the abutment, completely covering the metal underneath.

Fulfilling high expectations

Patients today want to be treated in an efficient and expedient manner. For years, we have been able to extract single-rooted teeth, place implants immediately into the socket sites and immediately load the implants thanks to well-developed protocols for such cases.
With the NobelActive implant, we can now do the same in multi-rooted teeth situations—and with very predictable long-term results, I believe— as long as we carefully follow the surgical and implant placement guidelines.

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