Patient Complaint: A patient visited our clinic with the primary concern of a broken lower right back tooth and frequent food lodgment in that area, which was causing discomfort while chewing.

Clinical & Radiographic Examination:

On intraoral examination:

  • Root stumps were noted in the region of tooth 46 (lower right first molar)
  • Surrounding gingiva appeared inflamed, and food debris was present in the area

A CBCT scan was advised to evaluate:

  • Bone volume and density
  • Relationship to the inferior alveolar nerve
  • Suitability for immediate implant placement

CBCT Findings:

  • Sufficient bone height and width
  • No pathology involving adjacent teeth
  • Safe distance from the mandibular canal

Treatment Plan:

Atraumatic extraction of root stumps irt 46 Immediate placement of a single implant in the same region All performed under local anesthesia Final prosthesis planned after 3–4 months of healing

Surgical Procedure: Immediate Implant Placement in 46 Region

1. Anesthesia & Preparation:

  • Local anesthesia administered using inferior alveolar and buccal nerve blocks
  • Surgical area disinfected and isolated for sterile protocol

2. Atraumatic Extraction:

  • Tooth 46 (root stumps) extracted using periotomes and luxators to preserve alveolar bone
  • Socket curetted thoroughly to remove any granulation tissue
  • Irrigation with saline and betadine to disinfect the site

3. Osteotomy Site Preparation:

  • Initial pilot drill placed in the interradicular bone (between mesial and distal roots)
  • Sequential drills used to enlarge the osteotomy, with continuous saline irrigation
  • Parallelism and angulation confirmed clinically and radiographically
  • Care taken to maintain minimum 2 mm from mandibular canal

4. Implant Placement:

  • A tapered, rough-surfaced titanium implant (e.g., 4.2 mm x 10 mm) was inserted
  • Achieved good primary stability (>35 Ncm) due to dense posterior mandibular bone
  • Cover screw or healing abutment placed, depending on soft tissue level

5. Socket Management:

  • Minor gaps between implant and socket walls filled with bone graft material
  • Site closed with simple interrupted 3-0 sutures to ensure soft tissue adaptation

6. Post-Operative Instructions:

  • Antibiotics and anti-inflammatory medication prescribed
  • Cold compress advised for the first 24 hours
  • Soft diet for a week, avoid chewing directly on implant side
  • Chlorhexidine mouthwash twice daily
  • Suture removal scheduled in 7–10 days

Follow-Up Plan:

  • Healing and osseointegration monitored over 3–4 months
  • Final prosthesis: single implant-supported crown to be placed after complete integration

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