Prosthetically driven immediate implant placement at lower molar area; an anatomical study

Area of Science:

• Oral and Maxillofacial Surgery
• Dental Implantology
• Radiology

Background:

• Immediate implant placement (IIP) in the posterior mandible is a common procedure.
• Assessing anatomical risks is crucial for IIP success and patient safety.
• Mandibular canal perforation (MCP) and lingual plate perforation (LPP) are potential complications.

Purpose of the Study:

• To evaluate the effectiveness and safety of immediate implant placement (IIP).
• To assess the risk of lingual plate perforation (LPP) and mandibular canal perforation (MCP).
• To investigate the association between posterior mandible anatomy and perforation risks using cone beam computed tomography (CBCT).

Main Methods:

• A morphological study of 135 patients' molar sockets was conducted.
• The relationship between socket anatomy and the mandibular canal was analyzed.
• Risk of LPP and MCP was recorded, and mandibular cross-sectional morphology was classified (U-P-C).

Main Results:

• The risk of LPP was significantly higher for second molars and increased with age.
• A strong relationship was found between LPP risk and cross-section type U.
• The mean root to alveolar canal (RAC) distance was greater in males (5.02 mm) than females (3.49 mm).
• MCP risk showed a significant relationship with cross-section type U, but not with sex.
• MCP risk was higher in second molars, but not statistically significant.

Conclusions:

• Immediate implant placement in the mandibular molar region carries a significant risk of MCP and LPP.
• Posterior mandible anatomy, particularly type U cross-sections and second molar sites, increases perforation risks.
• A delayed implant protocol is advisable to mitigate these risks.