Immediate Implantation – tooth 12-11-21-22

clinical case
Performed by Dr. Gadi Schneider, periodontist
In this article we present the case of a 56-year-old female patient, With generalized severe chronic periodontitis and teeth 12-22 with 2-3 mobility grade and hopeless 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 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.

Initial photo and CT scan of the patient,
A 56-year-old woman comes to our clinic with generalized severe chronic periodontitis, hopeless 12-22 teeth. She 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 12-22 and immediate placement of TUFF classic implants in areas 12-22. 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 4 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 that the patient will wear. The patient’s mouth is scanned with a Sirona scanner and sent to the laboratory where a PMMA prosthesis is manufactured and placed in the patient after the implantations.

  • Periodontal treatment and re-evaluation
  • Extraction 12-22
  • Immediate implantation of TUFF implants 12-11-21-22
  • Bone augmentation – in the sockets between the implants and the buccal plates
  • Immediate loading with PMMA bridge 12-22
  • Final rehabilitation – 12-22 screw-retained zirconia bridge


Surgical procedure
  • Extractions 12-22
  • Drill 2 mm – guiding pins and parallel examination
  • Palatal position and inclination
  • Intact buccal plates


Surgical procedure
  • Placing 4 3.75/11.5 Tuff implants  12-11-21-22
  • Drill 2.8 mm – 3.2 mm only expanding the coronal part of the osteotomy
  • Palatal position and inclination
  • Intact buccal plates
  • Placing bovine bone between the implants and buccal plates
  • Insertion tourqe > 40 Ncm


The success of the procedure depends on the skill of the clinician since it is not an easily used technique., 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 in 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 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 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


more Clinical cases

Receive the latest news

Subscribe to our newsletters and blogs

We’ll keep you updated with current product news, special offers, events and more: