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Journal Club Presentation
Dr. Supratim (JR 3)
• Immediate dental implants
• Essential factors: Initial Stabilization of implant with apical and/or lateral bone
• Initial stability in molar extraction socket : Challenging
Challenges
• Width of the alveolar socket
• Poor bone quality
• Anatomical limitations beyond the molar apices: e.g. Maxillary sinus, IAN
Morphology of molar extraction sockets
• Septal bone
• Periphery of the molars
• Converging/Diverging roots
• CLASSIFICATION SYSTEM FOR MOLAR EXTRACTION SOCKETS BASED ON
MORPHOLOGY OF SEPTAL BONE
• Type A
• Type B
• Type C
Treatment Protocols
Type A Sockets
• Adequate septal bone
• Implants placed with no gaps around it
• Torque > 15 Ncm 86% survival rate
• Torque > 30 Ncm 90% survival rate
• Grafting not necessary
• Sockets of roots may be grafted for better remodelling
• Inadequate buccal bone = Not a problem
Type A sockets
• Alternative to septal placement:
• Placement in the tooth socket: Palatal root of maxillary molars
• Too far Palatal positioning = partially cantilevered crown
• Hygiene difficult
• Mandibular = poorly positioned screw access opening
• Need of angulated abutment to redirect the opening
Type B sockets
• Implant is stabilized but not fully contained by the septal bone
• Gap b/w implant and inner wall of socket
• Gap < 2 mm will fill in with bone without grafting
• Gap > 2 mm and primary closure can achieved = Grafting needed
• If ridge architecture is necessary = Grafting needed
• If additional buccal wall missing = Delayed implant
Type C sockets
• Immediate implant should engage 3-5 mm apical bone for primary stability
• Difficult in molar sockets
• No septal bone = engaging of perimeters of socket walls is necessary
• Better option = Delayed implants
• If immediate = Wider implants ( 7-9 mm diameter)
• Avg buccolingual width of molars = 8-9 mm
• hourglass shaped socket = implant width 6-9 mm to engage buccal /lingual walls
Guidelines for extractions
• No full thickness mucoperiosteal flap = to prevent significant remodeling
• Sectioning of molars = preserve septal bone
• Allow elevation of individual roots
Conclusion
• New classification system for molar extraction sockets
• Help to decided treatment protocol
• Immediate placement can be made more predictably
Thank You

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CLASSIFICATION Of molar extraction sites.pptx

  • 2.
  • 3. • Immediate dental implants • Essential factors: Initial Stabilization of implant with apical and/or lateral bone • Initial stability in molar extraction socket : Challenging
  • 4. Challenges • Width of the alveolar socket • Poor bone quality • Anatomical limitations beyond the molar apices: e.g. Maxillary sinus, IAN
  • 5. Morphology of molar extraction sockets • Septal bone • Periphery of the molars • Converging/Diverging roots
  • 6. • CLASSIFICATION SYSTEM FOR MOLAR EXTRACTION SOCKETS BASED ON MORPHOLOGY OF SEPTAL BONE • Type A • Type B • Type C
  • 7.
  • 8. Treatment Protocols Type A Sockets • Adequate septal bone • Implants placed with no gaps around it • Torque > 15 Ncm 86% survival rate • Torque > 30 Ncm 90% survival rate • Grafting not necessary • Sockets of roots may be grafted for better remodelling • Inadequate buccal bone = Not a problem
  • 9. Type A sockets • Alternative to septal placement: • Placement in the tooth socket: Palatal root of maxillary molars • Too far Palatal positioning = partially cantilevered crown • Hygiene difficult • Mandibular = poorly positioned screw access opening • Need of angulated abutment to redirect the opening
  • 10.
  • 11. Type B sockets • Implant is stabilized but not fully contained by the septal bone • Gap b/w implant and inner wall of socket • Gap < 2 mm will fill in with bone without grafting • Gap > 2 mm and primary closure can achieved = Grafting needed • If ridge architecture is necessary = Grafting needed • If additional buccal wall missing = Delayed implant
  • 12.
  • 13. Type C sockets • Immediate implant should engage 3-5 mm apical bone for primary stability • Difficult in molar sockets • No septal bone = engaging of perimeters of socket walls is necessary • Better option = Delayed implants • If immediate = Wider implants ( 7-9 mm diameter) • Avg buccolingual width of molars = 8-9 mm • hourglass shaped socket = implant width 6-9 mm to engage buccal /lingual walls
  • 14.
  • 15. Guidelines for extractions • No full thickness mucoperiosteal flap = to prevent significant remodeling • Sectioning of molars = preserve septal bone • Allow elevation of individual roots
  • 16. Conclusion • New classification system for molar extraction sockets • Help to decided treatment protocol • Immediate placement can be made more predictably
  • 17.
  • 18.
  • 19.

Editor's Notes

  1. A newton centimeter (N·cm) is a decimal fraction of a newton meter, which is a derived SI unit of torque (also called “moment” or “moment of force”). One newton meter is equal to the torque resulting from a force of one newton applied perpendicularly to a one-meter-long moment arm.