Patient Profile A patient presented with complaints of pain and food lodgment in the upper left back tooth region.

  • Tooth Involved: 26
  • Medical History: Not significant
  • Clinical Findings: Grossly decayed, previously root canal-treated tooth with furcation involvement
  • Imaging: CBCT advised to evaluate bone levels and proximity to the sinus.

Diagnosis

  • Failed RCT in tooth 26 with vertical bone loss and furcation involvement.
  • CBCT revealed sufficient bone height and width for immediate implant placement after extraction.

Treatment Plan

  • Extraction of Tooth 26
  • Immediate implant placement under local anesthesia
  • Postoperative healing for 3 months
  • Implant crown placement after osseointegration

Surgical Procedure (Step-by-Step)

1. Pre-Surgical Preparation

  • Patient consent obtained.
  • Pre-procedural rinse with 0.12% chlorhexidine.
  • Local anesthesia administered (2% lignocaine with adrenaline 1:80,000).

2. Atraumatic Extraction of Tooth 26

  • Tooth sectioned into roots to minimize trauma.
  • Individual roots removed carefully using periotomes and elevators.
  • Care taken to preserve the buccal and palatal cortical bone plates.
  • Socket debrided thoroughly and irrigated with saline to remove granulation tissue.

3. Immediate Implant Placement

  • Osteotomy site prepared in the inter-radicular septal bone under copious saline irrigation.
  • A titanium dental implant (appropriate length and diameter based on CBCT) was placed with primary stability achieved (insertion torque >35 Ncm).
  • Minor gap between implant and socket walls grafted using bone graft material.
  • Cover screw placed.

4. Suturing

  • Site closed using 3-0 or 4-0 resorbable sutures to ensure flap approximation.
  • Postoperative instructions given.

Postoperative Care

  • Antibiotics and analgesics prescribed.
  • Ice packs advised for first 24 hours.
  • Soft diet and chlorhexidine mouthwash recommended.
  • Sutures left to resorb or removed after 7–10 days.

Follow-Up

  • Healing monitored at 1 week, 1 month, and 3 months.
  • After successful osseointegration (confirmed clinically and radiographically), implant-level impression taken.
  • Final crown placed after 3 months using screw-retained or cement-retained protocol.

Outcome

  • Pain and food lodgment resolved.
  • Patient achieved full function and esthetics.
  • Long-term success expected with proper oral hygiene maintenance.

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