Immediate Molar Implants With Customized Healing Abutments in Different Post-Extraction Socket Classes

Evaluation of the Success of Immediate Implants in the Molar Region Using Individually Fabricated Healing Abutments (Sulcus Formers) in Different Classes of Post-Extraction Sockets: A Prospective Cohort Study

Immediate implant placement into a fresh extraction socket shortens overall treatment time and reduces the number of surgical procedures, but the fit between the implant and the socket walls, and the resulting soft-tissue contour, differ substantially between socket types. This study evaluates immediate implant placement in the molar and posterior region combined with an individually fabricated (customized) healing abutment, or sulcus former, that seals the socket and shapes the emergence profile from the day of surgery.

Consecutive patients with a non-restorable posterior tooth are treated with flapless atraumatic extraction, immediate implant placement, grafting of the residual gap, and a chairside customized healing abutment fabricated on a titanium temporary abutment. Participants are grouped by the class of the post-extraction socket (A, B or C) according to the interradicular septal bone available for primary stability.

Outcomes are preservation of peri-implant soft-tissue volume assessed with an intraoral scanner, preservation of alveolar bone volume assessed on cone-beam computed tomography, implant stability measured by resonance frequency analysis (ISQ) at placement and before loading, and time to definitive loading. Early wound healing on the Landry index, the degree of bone corticalization before loading, implant survival, healing-abutment complications and analgesic requirement are also recorded.

Inclusion Criteria:

• Age 18 years or over
• ASA physical status I or II
• A non-restorable posterior tooth (premolar or molar) indicated for extraction: clinically unrestorable crown, advanced chronic periodontitis, failed or untreatable endodontic therapy, or vertical root fracture
• Residual bone permitting implant placement with adequate primary stability
• Able and willing to give written informed consent and to attend the follow-up schedule

Exclusion Criteria:

• ASA physical status III or higher
• Pregnancy or lactation
• Uncontrolled diabetes mellitus
• Smoking more than 10 cigarettes per day
• Drug or alcohol abuse
• Current or previous bisphosphonate or other antiresorptive therapy
• Head and neck radiotherapy
• Immunosuppression
• Anticoagulant or antiplatelet therapy where the required pre-operative preparation is declined
• Psychiatric conditions preventing compliance with the study procedures
• Known titanium allergy
• Severe bruxism
• Acute infection at the surgical site
• Advanced alveolar resorption precluding immediate implant placement