A real case of transformation using extraction + immediate implant placement in both upper and lower jaws.
Patient Story
A 40-year-old patient visited our clinic with two major concerns:
- Pain in the upper left back region
- Missing tooth in the lower right back region
These issues were affecting chewing efficiency and causing discomfort during meals.
Clinical Examination & Diagnosis
- Tooth 25 and 26 (upper left second premolar and first molar): Grossly decayed and non-restorable
- Tooth 46 (lower right first molar): Missing
- No significant medical history
- CBCT advised to assess bone levels and anatomical landmarks
CBCT Findings
- Adequate bone height and width in regions 25, 26, and 46 for implant placement
- No signs of active infection or sinus involvement
- Clear path for immediate implant placement post-extraction
Final Treatment Plan
- Extraction of 25 and 26 under local anaesthesia
- Immediate implant placement in regions
- Healing phase followed by prosthetic restoration (crowns)
Surgical Steps in Detail
Step 1: Aseptic Preparation
- The patient was prepared in a sterile environment.
- Local anaesthesia is administered in the upper and lower arches to ensure a pain-free procedure.
Step 2: Atraumatic Extraction of 25 and 26
- Periotomes and elevators are used to preserve the socket integrity
- Sockets were carefully debrided to remove all granulation tissue
- Socket walls were evaluated for defects or thinning
Step 3: Implant Site Preparation (Upper Arch)
- Osteotomy was initiated using pilot drills
- Sequential drilling was done to the desired width and depth in both sockets
- Direction verified with paralleling pins
- Two implants were placed in the 25 and 26 region with good primary stability (Insertion torque >35Ncm)
Step 4: Implant Placement in Lower Arch (46 Region)
- Mid-crestal incision given with slight vertical releases
- Full-thickness flap reflected to expose the alveolar ridge
- Osteotomy was prepared with caution to avoid the mandibular canal
- One implant was placed with ideal angulation and depth
- Flap sutured back using resorbable sutures
Step 5: Closure & Post-Op Care
- Cover screws are placed on all implants
- Site irrigated with betadine and saline
- Sutures placed for primary closure
- Post-operative instructions given
- Antibiotics and analgesics were prescribed
Recovery & Next Steps
- A healing period of 3 months is advised
- Patient instructed to maintain oral hygiene and avoid pressure on implant sites
- Final crown placement scheduled after successful osseointegration
Takeaway
This case demonstrates how advanced implantology techniques allow us to replace multiple missing or decayed teeth in a single sitting, preserving bone and reducing overall treatment time.
If you're dealing with painful, decayed teeth or gaps affecting your chewing or smile, don’t wait. Modern dentistry offers comfortable, efficient, and lasting solutions.