Immediate Implant Placement in the Mandibular Molar Septum Using Osseodensification: A Case Report with 4-Year Follow-Up
Márcio de Carvalho FormigaJucielly Santos Lesnik de SouzaGustavo Dos Santos Coura
S. Gehrke
Aug 2026· Reports· Vol 9, pp. 278· 0 citations· 24 references
Medicine
TL;DR
The clinical outcome supports current evidence indicating that osseodensification may enhance initial stability and predictability of immediate implants placed in posterior mandibular regions.
Abstract
Background and Clinical Significance: Immediate implant placement in mandibular molars represents a clinical challenge due to lower trabecular bone density and anatomical limitations of the interradicular septum. Osseodensification has been proposed as an alternative to improve primary stability in sites with low bone quality. Case Presentation: This report describes the case of a 54-year-old female patient with a mesial root fracture in the lower right first molar, treated by atraumatic extraction followed by immediate implant placement using a densifying drilling protocol. After careful root removal, the interradicular septum was expanded using Versah burs at 1200 rpm, allowing placement of a 4.0 × 7 mm Implacil Duecone implant with a final insertion torque of 25 Ncm. The residual gap was filled with a xenogeneic bone substitute and covered with a dense polytetrafluorethylene membrane for alveolar preservation. Healing progressed uneventfully and, after four months, adequate bone formation was observed, enabling prosthetic rehabilitation with a single ceramic crown. After 4 postoperative years we could find peri-implant tissue stability. Conclusions: The clinical outcome supports current evidence indicating that osseodensification may enhance initial stability and predictability of immediate implants placed in posterior mandibular regions.
Immediate placement of implants in the posterior region of the mandible is achievable when sufficient bone height and primary stability are attained and the processes of socket grafting and atraumatic extraction are essential for achieving successful results in cases involving hopeless teeth.
Manveer Singh, Tarun Kalra1, Manjit Kumar· International Journal of Ora...· 0 citations
Longitudinal fractures in endodontically treated teeth, especially after trauma, often present an unfavorable prognosis, associated with pain, fistula, and bone resorption. Immediate implant placement associated with regenerative techniques and immediate loading can offer a predictable solution for esthetic and functional restoration. Case report: A 35-year-old female patient presented with longitudinal fracture of tooth #12 with periapical lesion and fistula. Careful extraction, curettage, and socket decontamination with active oxygen gel (blue®m) were performed. A Helix Acqua GM Neodent implant (3.5 × 16 mm) with 60 N·cm insertion torque was placed, positioned 3 mm subcrestal. A universal abutment torqued at 20 N·cm was adapted, followed by placement of a provisional tooth previously milled in PMMA. The bone defect was filled with bone graft (Straumann® cerabone®)) and covered with a resorbable membrane (Straumann® Jason® membrane), associated with a de-epithelialized connective tissue graft from the palate. Clinical and radiographic follow-up demonstrated fistula resolution, provisional stability, preservation of peri-implant tissues, and favorable esthetic contour. Conclusion: Single-stage treatment combining immediate implant placement, immediate loading, bone grafting, connective tissue grafting, and active oxygen gel proved to be an effective alternative for root fracture cases in the esthetic zone, providing predictable rehabilitation with satisfactory clinical and esthetic results.
R. Pes, Evandro Antonio Garcia, Hassan Yussef Saleh et al.· Journal of Orofacial Innovat...· 0 citations
Background: Autologous dentin has emerged as a potential grafting material in regenerative oral surgery because of its structural and biological similarities to bone. This technical report describes a modified tooth-shell technique used for horizontal ridge reconstruction with simultaneous implant placement in two clinical cases involving the aesthetic zone. Case Presentation: The first case involved a 29-year-old female patient requiring extraction of a partially impacted, buccally positioned maxillary third molar (tooth 28). The extracted tooth was processed intraoperatively to obtain a dentin shell, which was fixed as a buccal plate during simultaneous implant placement. The remaining defect was filled with sticky bone prepared from biphasic calcium phosphate combined with platelet-rich fibrin. Radiographic evaluations performed at 4 and 6 months demonstrated stable ridge contours, while clinical follow-up continued for 2 years with maintenance of implant function and peri-implant tissue stability. The second case involved a 58-year-old female patient with a previous failure of immediate implantation in the anterior maxilla associated with implant overload, loss of implant stability, and buccal bone deficiency. After soft- and hard-tissue healing, ridge reconstruction was performed using a dentin shell prepared from tooth 18 together with simultaneous implant placement and immediate provisional restoration. Follow-up after 6 months revealed stable peri-implant tissues, a satisfactory aesthetic outcome, and successful prosthetic rehabilitation. Conclusions: The modified tooth-shell technique using autologous dentin provided satisfactory preliminary clinical and radiographic outcomes in both cases. These findings should be considered hypothesis-generating and require confirmation in larger prospective studies with longer follow-up periods.
Jan Łoś, Justyna Szałkowska-Łoś, Michał Pikuła et al.· Journal of Functional Biomat...· 0 citations
Immediate implant placement (IIP) and loading protocols have emerged as predictable treatment strategies in contemporary dentistry, particularly in the esthetic zone. These approaches offer advantages such as reduced treatment time, preservation of peri-implant soft tissue architecture, and improved patient satisfaction. However, biological and prosthetic prerequisites, including adequate bone and soft tissue support and primary stability, must be fulfilled to ensure long-term success. This case report presents the management of an 18-year-old female patient with high esthetic demands who underwent IIP, grafting, and provisionalization in the maxillary anterior region. Following atraumatic extraction and implant placement with sufficient stability, grafting was performed and a screw-retained provisional restoration was delivered within 24 h. After a 3-month healing period, definitive zirconia implant-supported restorations were fabricated and cemented. Over a 10-month follow-up, no complications were observed, and satisfactory esthetic and functional outcomes were achieved. The results indicate that, with proper case selection, sufficient primary stability, and careful prosthetic planning, immediate implant loading can provide reliable and predictable outcomes.
M. N. Ürün, M. Toprak, Serdar Polat· Akdeniz Diş Hekimliği Dergis...· 0 citations
The findings of this preliminary case series suggest that the auto-augmentation technique from the mandibular symphysis is a technically feasible protocol for horizontal ridge augmentation, and achieves adequate bone gain while minimizing donor-site trauma and optimizing patient recovery profiles.
Hossam Saleh, R. Eldibany, Dina M N Metawie· BMC Oral Health· 0 citations
Background: Guided bone regeneration (GBR) improves the feasibility of implant placement, while computer-assisted implant surgery (CAIS) enables optimal 3-D positioning for better esthetic outcomes with implant-supported fixed partial dentures (ISFPD). This case report presents a digital workflow for CAIS and immediate ISFPD loading in a partially edentulous mandibular anterior region following GBR.Case Report: A 20-year-old female patient was referred for rehabilitation of a partially edentulous mandible due to functional, phonetic, and esthetic concerns. The most preventive, durable, and comfortable ISFPD treatment was selected to replace the missing teeth. Insufficient horizontal bone volume was restored using GBR with a block graft from the symphysis region, secured with graft pins, supported by an autogenous and allograft mixture, covered with a collagen membrane, and closed with a repositioned flap. After six months of healing and digital implant planning, two dental implants were placed in the locations of 32 and 42 using a tooth-supported CAIS with a flapless guided surgery protocol and immediately loaded with a screw-retained temporary ISFPD. The temporary ISFPD was modified and replaced with a partially veneered monolithic zirconia definitive ISFPD after a 3-month healing period. The accuracy of implant placement was evaluated using a metrology-grade 3-D analysis software.Conclusion: In cases of insufficient bone thickness, GBR augmentation can effectively increase bone volume, enabling precise implant placement through guided surgery. Lower linear (0.35 - 1.77 mm) and angular (2.19° and 3.18°) deviations suggest that using CAIS can improve the accuracy of implant placement, and it is necessary to achieve predictable implant placement and favorable prosthetic outcomes.
Meleknaz Arıcı, Figen Öngöz Dede, Doğu Ömür Dede et al.· MIDDLE BLACK SEA JOURNAL OF...· 0 citations
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