Replacement of an Endodontically Compromised Mandibular Left First Molar with Immediate Implant Placement and a Sealing Socket Abutment (SSA)
In his case, Garry Finelle outlines a minimally invasive strategy for replacing molars. In this treatment protocol, a customized anatomical healing abutment (SSA) is used to obturate the socket - stabilizing the blood clot, preventing loss of bone augmentation materials, and preventing the collapse of the surrounding soft tissue.
A 31-year-old woman was referred to the clinic by the endodontist for replacement of the mandibular left first molar (tooth 36) with a dental implant. According to the patient, tooth 36 was sensitive to heat and cold. The patient also reported discomfort and sensitivity during mastication, and mobility of tooth 36. The tooth was vital but sensitive to percussion. The radiographic evaluation showed a large radiolucency surrounding the pulp chamber of tooth 36, which was diagnosed as an irreversible external resorption; the tooth was therefore considered non-restorable.
Surgical classification
Complex
Prosthodontic classification
Straightforward
Learner Level
|
1
|
2
|
3
|
Source
Treatment Guide 14
CME/CPD
0.25 hours
Purchase price
10
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General Risk Assessment
Patient-related Factors
| Oral hygiene | Good |
|---|---|
| Compliance | Good |
Patient-medical Factors
| Medical Fitness | Healthy, able to undergo planned anesthesia and surgical procedure (ASA I) |
|---|---|
| Medications | No medications that would negatively affect the surgical procedure and outcomes. |
| Radiation Treatment | None |
| Growth Status | Complete |
Site-related Factors
| Periodontal Status | No history of periodontal disease, or any active periodontal disease. |
|---|---|
| Access | Adequate |
| Pathology near the implant site | None |
| Previous surgeries in planned implant site | No previous procedures. |
Surgical Classification
Surgical Complexity
| Timing of placement | Immediate Placement (extraction sockets) (Type I) |
|---|---|
| Simultaneous or Staged grafting procedures | Implant placement with simultaneous hard and soft tissue procedures |
Anatomy
| Bone Volume - Horizontal | Adequate |
|---|---|
| Bone Volume - Vertical | Adequate |
| Keratinized Tissue | Sufficient (>4 mm) |
| Soft Tissue Quality | No scars or inflammation |
| Proximity to vital anatomic structures | Moderate risk of involvement |
Adjacent Teeth
| Papilla | Complete |
|---|---|
| Recession | Absent |
| Interproximal attachment | At CEJ |
Extractions
| Radicular morphology | Multi-radicular/divergent roots - available interseptal bone |
|---|---|
| Available apical bone to achieve primary stability | Sufficient height ( ≥ 4 mm) and width (> 2 mm around apex of planned implant) |
| Socket walls | Intact |
| Thickness of buccal wall | 2mm or greater |
| Inter-radicular bone (multi-rooted teeth) | Wide - allowing drilling and implant anchorage |
| Anticipated residual defect after implant placement | 2 mm or less |
Prosthodontic Classification
Complicating Factors
| Biological | Screw-retained restorations with appropriate contours |
|---|---|
| Mechanical/Technical | Absence of contributing factors |
Prosthesis Factors
| Prosthetic volume | Adequate. Space available for ideal anatomy of the restoration |
|---|---|
| Inter-occlusal space | Adequate. Capable to create an anatomically & functionally correct planned restoration |
| Volume and characteristics of the edentulous ridge (fixed) | Adequate. No adjunctive therapy or prosthetic soft tissue replacement will be necessary |
Occlusal Factors
| Occlusal scheme | User-defined occlusal scheme achievable |
|---|---|
| Involvement in occlusion | Involvement |
| Occlusal parafunction | Absent |
Complexity
| Loading Protocol | Early/Conventional |
|---|---|
| Interim prosthesis | None required |
| Implant-supported provisional restoration | None required |
| Timing of placement | Immediate Placement (extraction sockets) (Type I) |
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