Here is a super simple case and I this shows the type of first case that someone who has never done an immediate molar should tackle. Lots of bone between the crest of the furcation and really wide roots. Furcation abscess #19, gave the option of extraction and implant vs send to endo to retreat then perio for osseous surgery. Even after that with the short roots we are looking at a pretty guarded prognosis. Patient opted to extract and do an implant as #20 went pretty smooth. Flattened the tooth after removing the crown and scanned in CEREC.
You can see in the cross sectional view that there is a lot of bone height on the lingual but at the level of the furcation bone we are a lot more low. The top of the implant has to be at that level. Even with grafting I don’t think we can get a lot of height in these areas. Milled out a CEREC Guide 2.
Drilled through a hole I made in the furcation of the tooth to keep the roots centered. I used to advocate just drilling with the 2.3mm pilot but now I am taking it up to a 2.8 just so the other drills don’t walk. Sectioned and extracted the medial and distal roots.
Always use a short drill to assess angulation and take a PA and count the notches. You can see we are at the 11.5mm mark. Replaced the guide and drilled up to the 5.1mm using a Large guide sleeve and my keys for Implant Direct. Used an HA coated implant, just cuz it looks bad ass :}! No that was all we had. In this case SBM would have worked just fine.
Great stability, looks like I am a little more distal than I planned. This case was not fully guided, there would be no way to get the 7mm implant through the guide, but this is a common problem in immediate implants as you really are only engaging a few mm of bone apical to the extraction site. Placed the healing abutment through the membrane and packed DFDBA DirecGen cadaver bone with Villet sutures, which should resorb in about 2 weeks.