Immediate Implantation – tooth 11

clinical case
Performed by Dr. Gadi Schneider, periodontist
In this article, we present the case of a 56-year-old male patient, healthy With severe pain and grade 2 mobility of tooth no. 11 due to a large periapical cyst. The patient asked for extraction, immediate implantation, and bone augmentation on the same day. Immediate loading wasn’t necessary because we had to replace the crown of tooth no.21 . We planned to deliver 2 temporary crowns 11-21 supported by tooth 21.

Nowadays we find more and more cases of patients who demand a fast and effective solution for their tooth loss problems. Often, these patients have severe bone atrophy, so to meet these demands we should offer them immediate implantation with classic implants and loading with their respective GBR (guided bone regeneration) surgeries since this type of treatment is reliable and quite predictable.


A 56-year-old man comes to our clinic with hopeless 12 teeth due to a very large periapical cyst He underwent a clinical examination, photographs, complete RX series, and CT scan. We plan the extraction of tooth 21 and immediate placement of 4.2 / 18 mm TUFF classic implant in area 11. Given the demands of the patient to have teeth immediately and not to wait too long to finish the whole treatment, leads us to choose immediate implantation combined with bone augmentation, flapless surgery, and 11-21 temporary crowns.

After the initial preparation we proceeded to extractions 18 mm TUFF  implan was placed. The implant was placed with a minimum torque of 40Ncm. The patient’s mouth was scanned with a Sirona scanner 1 week before and was sent to the laboratory where an a11-21 PMMA prosthesis was manufactured and delivered to the patient after the implantations.

Surgical procedure
  • Extractions 11
  • Drill 2 mm – guiding pins and parallel examination
  • Palatal position and inclination
  • Intact buccal plates

Surgical procedure
  • Drill 2.8 mm – 3.2 mm only expanding the coronal part of the osteotomy
  • Placing 4.2/18 Tuff implant 11
  • Palatal position and inclination
  • Intact buccal plates
  • Placing bovine bone between the implants and buccal plates
  • Insertion tourqe > 40 Ncm

Summary and conclusions
  • Immediate implantation with an 18 mm TUFF implant to cross the periapical cyst and gain high primary stability from the healthy bone apical to the cyst. This is the treatment of choice if it is possible according to the diagnosis
  • The surgery should be done flapless if there are no soft or very large bone defects present
  • The procedure is very technique-sensitive and hence high surgical skills are needed
  • The position of the implants is the key factor for the best clinical and aesthetic results
  • Immediate implantation and bone augmentation have very high success rates the same as conventional implantation and even higher in a lot of articles

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