Immediate Molar Implant Near An Abscess, bad idea?

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Posted on By Enrico Wensing In Implants

This strong young healthy male patient has presented to my office for an immediate implant placement at the lower left first molar site, to replace his failing root canal tooth.

The attached images show an extensive abscess associated with the distal root. No signs or symptoms clinically.

Digital planning reveals the implant can be 12mm long with a 4.8 diameter and land nicely 4mm above the inferior alveolar canal.

What are your thoughts about immediate placement? Good idea? Remove tooth , bone graft and then delay the implant placement? How do you debride such a large abscess near the IAN canal?

Any tips, ideas, and thoughts would be greatly appreciated. Thank you.

EJW DDS, PhD

Immediate Implant Photo #1
Immediate Implant Photo #2

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6 Comments

Hi, Implantation is the best next step when a root canal and crown fail, a dental implant feels and works just like your natural tooth. The implant process is done by gently and painlessly inserting a titanium root replacement into the jawbone. You can eat the foods you love easily and won’t experience the speech problems that some dentures can cause. But I won't recommend a dental implant near an abscessed tooth. You can do a dental implant at a later stage, once it's clear all the infection has been removed. You can wait for some time, after that you can proceed with an implant.


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It seems that the mesial root of 2nd molar is or could be involved too. I have a couple of cases that vital test performed, waited 4-6 months for bone reconstruction after extraction, vital test again before implant surgery- again- everything normal, place implant and implant failure within a short period of time, ended up Root Canal on adjacent tooth. Today in cases like that I do the RCT on the adjacent tooh, prior tooth removal.


Reply

Thank you so much for your helpful comment. - Enrico W. DDS


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A staged approach is best here. Be careful with debridement near IAN as it can be traumatized causing parathesia. Also, vitality test of adjacent molar. Possible endo required there as well prior to implant placement after healing period of 4-5 months. Regards Dr. Salama


Reply

Thank you Dr. Salama! - Enrico


Reply

Thanks ENRIQUE TREVINO to offer such a helpful answer, but I didn't hear about tooth removal. Please explain me why tooth removal is mandatory?


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