Immediate Implantation – tooth 11,12,21

clinical case
Performed by Dr. Gadi Schneider, periodontist
In this article we present the case of a 65-years-old male patient, With generalized severe chronic periodontitis and teeth 12-21 with 2-3 mobility grade and hopless prognosis. The patient demands are for teeth in a day meaning extraction, immediate implantation, bone augmentation and immediate loading in the same day.

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


A 65-year-old man comes to our clinic with generalized severe chronic periodontitis, hopeless 12-21 teeth. he underwent a clinical examination, photographs, a complete RX series, and a CT scan. We plan periodontal treatment that includes initial preparation, root planning, and re-evaluation after 1 month., later extraction of teeth 12-21 and immediate placement of TUFF classic implants in areas 12-21. 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 and loading combined with bone augmentation and flapless surgery.

After the initial preparation, we proceeded to extractions and 3 TUFF implant placement surgery that we had planned… All of them are placed with a minimum torque of 40Ncm so we can use the upper implants to support the cemented-retained provisional immediate prosthesis.


Surgical procedure
  • Extractions 12-21
  • Preparing a pouch in the buccal part of 11
  • Intact buccal plates
  • Placing collagen membrane

Surgical procedure
  • 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 3 3.75/11.5 Tuff implants  11-21-22
  • Insertion tourqe > 40 Ncm
  • Placing bovine bone between the implants and buccal plates


The success of the procedure depends on the skill of the clinician since it is not an easily used technique and not all surgeons are qualified to perform it. On the other hand, late implants are much easier to place, since their use has become very widespread in recent years, and they have become a conventional treatment.
Even so, for the teeth-a-day cases, the clinician must also have certain skills, since we are talking about cases of large maxillary bone atrophies where the placement of conventional implants is done with regenerative techniques of certain complications, such as sinus lifts bone augmentations, soft tissues repairs and flapless surgeries.
On the other hand, we believe that time can be a more determining factor since nowadays, the demands of our patients are increasingly greater. If we place immediate implants, we could have the complete rehabilitation finished, with a definitive prosthesis, in 4/5 months, while late implants with bone grafts would take longer than that time.
In addition, the indisputable advantage of being able to wear a fixed temporary prosthesis from the first moment, while, if we perform late implants, the only prosthesis we could use would be a removable one, and not in all cases.

Summary and conclusions

Immediate implantation and loading 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 loading procedures `have very high success rates the same as conventional implantation and even higher in a lot of articles

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