Immediate Implant Placement in Upper 2nd Premolar

Cesar Luchetti

Department of Implant Dentistry. National University of La Plata. Argentina

The immediate implant placement is today a routine approach. However, it must fulfill a series of conditions, between which is the achievement of a good initial anchorage, like in conventional implantology. This initial fixation normally is looked for creating the bed beyond the apex of the extracted piece, that is why some colleagues also denominate them trans-alveolus immediate implants.

Nevertheless, in certain situations it is not possible to go beyond the apex, due to anatomical limitations, as in the case of the upper second premolars and its proximity with the maxillary sinus.

Here we presented a case of immediate placement where the anchorage is obtained by means of the sidewalls of the residual alveolus.

Pre-operative situation. Root non-recoverable.

In the x-ray, the intimate relation of contact

between the apex of the piece and the cortical

of the maxillary sinus is observed.

After extraction socket with oval shape.

We decide the direct placement, without using

other instrument to modify the socket.

An implant of 4.5 mm of diameter (Steri-Oss)

was chosen to maximize the contact with the

mesial and distal walls.

The residual spaces are completed with a

bovine hidroxyapatite graft and soft tissue

closure was obtained with a partial thickness

palatal flap. X-ray shows the intimate position

of the implant respect the sidewall and the floor

of the maxillary sinus.

Implant uncovering and placement of the

definitive abutment

Metal substructure try in and definitive

metal-ceramic crown in place

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