Immediate vs Delayed Implant Placement

If the tooth in question demonstrates a Class II furcation involvement characterized by such periodontal destruction as to render it non-maintainable, or if a Class III furcation involvement is present, the tooth is extracted and regenerative therapy performed before it is replaced with an implant, abutment and crown. The question then becomes whether to place the implant at the time of tooth removal and perform regenerative therapy in the residual extraction socket defect, or rebuild alveolar bone in the region through regenerative therapy and place the implant during a second surgical visit.¹

The sine qua non of immediate implant placement is, of course, ideal positioning of an appropriate diameter implant for the tooth being replaced. If there is any doubt regarding the ability to attain this goal, an implant is not placed at the time of mandibular molar extraction. Rather, regeneration is accomplished, and the implant is placed after sufficient healing of the regenerated bone.

Following osseointegration of an ideally positioned implant in a molar socket, the dentist carries out the necessary restorative therapy. Ideally, an implant design that allows the crown to rest on the neck of the implant is preferable in these areas, as studies have demonstrated a reduction of stresses to both the peri-implant crestal bone and abutment interface when the crown rests on the implant body rather than the abutment (Figure 1 through Figure 6).

As with most dental treatment, comprehensive periodontal care typically begins in the restorative practice. It is the restorative dentists and their teams who must recognize furcation involvements as early as possible, minimizing the extent of care required to predictably keep the tooth. It is the restorative dentists and their teams who must be well versed in the indications and contraindications of each treatment modality as it relates to the individual patient. Explaining patient needs and motivating the patient to see the specialist also fall on the restorative dentist. Following the appropriate referrals, all team members must discuss the challenges they face and formulate a unified, comprehensive treatment plan. Execution of the treatment plan is multidisciplinary, as discussed in this paper. Through comprehensive understanding, effective communication and patient-centered care, the extended clinical team can help maximize treatment success while minimizing trauma.

Reference

1. Fugazzotto PA. Implant placement at the time of mandibular molar extraction. J Periodontol. 2008;79:737–747.

This information originally appeared in Brodsky A, Fugazzotto PA. Treatment approaches to periodontally furcated mandibular molars. Decisions in Dentistry. 2021;7(6)26–31.