Immediate implant placement and provisionalisation of a mandibular first molar

The aim of this article is to present a case of immediate implant placement and provisionalisation of a mandibular molar with the PrimeTaper EV implant (Dentsply Sirona). This case report is published as an inspiration for dental professionals and not necessarily as a recommendation.

A 39-year-old male patient presented with a deeply fractured mandibular first molar two years after hemisection (Fig. 1). After the patient had opted for an implant-borne solution, an immediate implant placement and restoration with a PMMA provisional crown on a final Atlantis abutment (Dentsply Sirona) was planned.

The implant site was prepared following the recommended drilling protocol for the planned PrimeTaper EV 4.2mm diameter implant (drills #1, 3 and 4; Fig. 2). After cortical preparation with drill #5, the implant was placed. The preparation was nalised with a tap, owing to dense trabecular bone (Fig. 3). The implant was inserted to a torque of 42Ncm (Fig. 4).

Immediately after implant placement (Fig. 5), the abutment position was registered with an intra-oral scan using Primescan (Dentsply Sirona; Fig. 6). At the end of the surgical procedure, the socket was grafted with Symbios (Dentsply Sirona) and a healing abutment was seated (Fig. 7). Radiographic evaluation was performed on the same day (Fig. 8).

Fig. 1: Deeply fractured mandibular first molar. Fig. 2: Implant site preparation. Fig. 3: Placement of implant. Fig. 4: Final torque of 45Ncm. Fig. 5: Implant in final position. Fig. 6: Intra-oral scan with Primescan (Dentsply Sirona) immediately after implant placement. Fig. 7: Socket grafted with Symbios and healing abutment placed. Fig. 8: Post-op radiographic evaluation.

On basis of an intra-oral scan, an Atlantis abutment and Atlantis provisional crown were designed and fabricated with an Atlantis IO FLO (Fig. 9).

Fig. 9: Design of Atlantis abutment and provisional crown.

One week after implant surgery, healing was satisfactory and the abutment and provisional crown were inserted (Figs. 10–14).
During the healing period, the nal crown was manufactured based on the Atlantis Core File. Eight weeks after implant placement, the soft tissue had healed well (Figs. 15 & 16) and was ready for the nal zirconia crown (Fig. 17). Radiographic evaluation with the nal restoration conrmed the successful outcome of the treatment (Fig. 18).