In this new clinical case, Dr. Amarouche presents the management of an immediate extraction and implantation in the posterior mandibular area, in a demanding anatomical context. The objective is to preserve tissues while ensuring optimal primary stability, a key step for long-term implant success.
The protocol highlights the combination of the iBone® E implant, selected for its ability to anchor effectively in post-extraction situations, and the iPhysio® Profile Designer, used to guide soft tissue healing and facilitate prosthetic temporization. This case illustrates a rigorous approach, combining surgical efficiency with optimal preparation for final restoration.
STEP 1 – INITIAL SITUATION
Tooth 46 shows irreversible damage, with infection and structural loss making preservation impossible. Extraction is indicated as part of an immediate implantation protocol aimed at quickly restoring masticatory function while minimizing tissue loss.
Pre-operative radiological analysis confirms sufficient residual bone volume to consider immediate extraction and implantation. The position of nearby anatomical structures, such as the inferior alveolar nerve, is carefully evaluated to ensure safe and predictable implant placement.
STEP 2 – IMPLANT SITE PREPARATION WITH IBONE® GUIDED SURGERY
Axial drilling is performed directly through the remaining tooth. This technique uses the roots as anatomical landmarks, ensuring optimal drilling guidance and precise implant axis alignment according to prosthetic requirements.
This protocol guarantees an insertion adapted to the future restoration, respecting the ideal trajectory for occlusal load and function.
STEP 3 – ATRAUMATIC EXTRACTION
After axial drilling, the remaining roots, now sectioned and weakened, are extracted using an atraumatic approach. This technique aims to preserve the integrity of the bone walls, particularly the buccal and lingual plates, essential for implant stability and the final aesthetic result.
Meticulous extraction minimizes tissue trauma and limits post-operative bone resorption, offering an ideal environment for immediate osseointegration and soft tissue healing around the implant.
STEP 4 – IMPLANT PLACEMENT IBONE® E IN POSITION 46
The iBone® E implant (4.3 mm x 6.2 mm x 10 mm) is inserted into the prepared site without bone stress. Thanks to its engaging threads, it provides effective anchorage in the buccal and lingual corticals, ensuring immediate primary stability, essential for this protocol.
The achieved stability secures the post-operative phase and creates optimal conditions for osseointegration.
STEP 5 – EMERGENCE PROFILE MANAGEMENT WITH IPHYSIO®
The peri-implant bone defect is filled with S1 Dental Medpark bone substitute to preserve the alveolar volume and support bone regeneration around the implant. The iBone implant design, characterized by a narrow body and wide threads, creates a healing space between the osteotomy site and the implant, promoting optimal osseointegration.
An iPhysio® C1 Profile Designer is then placed to guide soft tissue healing and stabilize the surgical site. Flowable composite is added to help seal the alveolus, stabilize the clot, and maintain soft tissues around the iPhysio®.
FINAL RESULT
The post-operative radiograph shows favorable healing of the implant site. The iBone® E implant is perfectly stabilized within the corticals, with good maintenance of bone volumes.
The iPhysio® Profile Designer remains in place, preserving the gingival contour and guiding soft tissue healing in preparation for the prosthetic phase. This passive prosthetic temporization helps stabilize the tissues and prepares an optimal environment for the next stage of treatment.
