top of page

Immediate Implant Placement at #36 & #37 with Surgical Removal of Mesially Impacted #38 and Management of Pulpitis #37

Surgical Procedure

Chief Complaint

Patient complains of severe pain on tooth #37 for the past few days.

Clinical Findings

  • #37 very TTP.

  • History of filling done last year with another operator due to sensitivity.

  • Sensitivity persisted after CAP.

  • Pain escalated significantly over the past few days.

  • CBCT:

    • #37 (d) caries to pulp with severe mesial angulation.

    • #38 mesially impacted against #37.

    • #36 missing.

Treatment Plan

Option 1:

  • RCT → Post & Core → Crown #37

  • Not ideal due to:

    • Mesial tilt of #37 causing non-axial loading

    • #38 still impacted → persistent food trap

  • Would resolve pain but with sub-optimal long-term prognosis.

Option 2 (Chosen):

  • Removal of mesially impacted #38

  • Removal of mesially tilted #37 with pulpitis

  • Immediate implant placement at #36 and #37 sites

  • Gap grafting using autogenous and alloplastic bone materials

Treatment plan discussed extensively. Risks, procedures and expected outcomes explained.
Patient advised to consider but opted to proceed on the same day.
Informed consent obtained for immediate implant placement surgery at #36 and #37.

Pre-operative Assessment

  • Digital treatment plan formulated and shown to patient.

  • CBCT reviewed: IDN not involved.

  • Good bone volume at #36 and #37 sites.

Anesthesia

  • LA block: Left IDN, LN, LBN

  • Additional LA infiltration at #28

Surgical Procedure

  1. Patient cleaned and draped.

  2. Incision made; buccal and lingual flaps raised.

  3. LA XAP removal of impacted #38 and mesially tilted #37.

  4. Curettage and removal of granulation tissue; saline irrigation.

  5. Implant osteotomies prepared at #36 and #37.

  6. Autogenous bone harvested from osteotomy sites.

  7. Implant placement:

  • Dentium Superline 5.0 × 8.0 mm implant at #36

    • 7.5 mm (M) healing abutment fitted

    • Dentium Superline 5.0 × 8.0 mm implant at #37

      • 6.5 mm (M) healing abutment fitted

  1. Bone grafting performed:

  • Autogenous bone + Dentium Osteon II Collagen alloplastic bone graft (6.0 × 10.0 mm × 2 packs)

  1. Surgipro™ polypropylene sutures × 11 for primary closure.

  2. Hemostasis achieved; POI given.

Management of #28:

  • LA XAP #28

  • Buccal fused roots very firm with dense bone

  • Surgical removal required but patient declined further surgery

  • Retained root (~3.4 mm × 2.5 mm) left in socket after consent

Hemostasis, POI

Post-operative Assessment

  • Post-op CBCT taken

  • IDN not involved

  • Implants well aligned with good positioning

  • Graft appears dense

  • Patient satisfied with overall outcome

  • Retained #28 buccal fused roots shown and explained; patient comfortable to monitor unless symptoms arise

bottom of page