Single Implant Restoration in a Premolar Area After Pre-extractive Implant Bed Preparation and Immediate Implant Placement

Background: Immediate implant placement has become an increasing treatment concept in daily practice. However, several factors have to be considered before tooth extraction in order to achieve functionally and esthetically satisfying results. One major prerequisite is primary stability. The challenge of immediate placement of an implant in premolar or molar sites is the implant bed preparation due to the presence of interradicular bone septa. Aim: This case report illustrates a step-by-step approach for the immediate placement of an implant in a premolar area in the upper jaw with pre-extractive implant bed preparation. Materials & Methods: A patient with a fractured and hopeless upper right first premolar presented in our clinic. All neighboring teeth were provided with intact fixed restorations. After clinical and radiographic analysis, a single crown implant restoration via immediate implant placement was planned. All drilling steps were performed directly through the remaining root, so that an optimal three-dimensional position of the implant could be achieved. After finishing the implant bed preparation, the remaining roots were carefully extracted in two parts. The socket walls were well conserved. After sounding of the height of the limbus alveolaris, the implant was placed with sufficient primary stability. The gap between the implant and socket walls was filled with bovine bone chips. A connective tissue graft was transplanted buccally via the envelope technique to stabilize gingival conditions. After a transgingival healing period of 4 months, the implant was provided with a CAD/CAM screw-retained implant restoration. Conclusions: From a clinical point of view, the concept of pre-extractive implant bed preparation allowed safe and precise positioning and angulation of an immediately placed implant. This is due to minimization of possible deflection of the osteotomy drills from the ridge of the bone septa. Therefore, the probability to achieve sufficient primary stability seems to be higher than in case of post-extraction implant bed preparation. Keywords: dental implants, immediate implant placement