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    Technique: Digital case management of a delayed immediate implant placement

    How the CS 3600 and CS Connect simplified case planning and execution.

    In February 2017, a 68-year-old female presented to my office with a toothache on the lower right side. She stated that the tooth had been hurting sporadically for a week and was worsening in duration and frequency. A review of her medical history showed high blood pressure controlled with medication, but otherwise no medical contraindications.

    Upon examination, it was revealed that tooth #30 had large MOD alloy that had fractured with large recurrent decay present. Tooth #29 had previous root canal treatment and a fractured crown; all that remained was the root. After diagnosing the site, I informed the patient of the following treatment options:

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    1. Do nothing, the risks of which could be drifting of adjacent teeth, continuance of the pain and discomfort, further supra-eruption of maxillary teeth and further atrophy of bone, which could make implant placement in the future more difficult.

    2. Extract teeth numbers 29 and 30 and restore with a removable partial denture. The patient stated she had no interest in a removable appliance.

    3. Extract teeth numbers 29 and 30 then restore site numbers 29 and 30 with a four-unit fixed partial denture (bridge). After discussion with the patient regarding bridge fabrication, she stated she preferred not to involve adjacent teeth.

    4. Extract teeth numbers 29 and 30 then restore with single tooth implants. We discussed the different types of implants that are available at this time to restore the site. We also discussed the process of a delayed immediate implant placement as well as bone grafting the extraction sites and returning for the implant placement in approximately three to four months. She was advised that during the procedure the surgeon may deem it more appropriate to abort the placement surgical procedure and graft the site or sites and place the implants at a later visit.

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    The patient was aware of alternative procedures and decided to restore teeth #29 and #30 with single-tooth Bicon Dental Implants. I extracted teeth numbers 29 and 30, and let it heal for two weeks; the patient then returned for a delayed immediate implant placement in the sites.


    Next: The treatment plan

    Dr. Robert Pauly, Jr.
    Dr. Pauley has been practicing dentistry in the Atlanta area since graduating from the University of Kentucky College of Dentistry in ...


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