Immediate Implant Placement by Drilling Through Roots

Immediate implant placement in molar extraction sockets can be challenging because of the anatomy of multirooted teeth and the difficulty of achieving an optimal implant position within the interradicular septum. Preparing the implant osteotomy before tooth extraction may allow the retained roots to guide drilling and improve implant positioning.

Participants requiring molar extraction and immediate implant placement were randomly allocated to one of two groups. In Group A, the implant osteotomy was prepared through the interradicular bone before extraction of the molar roots, followed by root extraction and immediate implant placement. In Group B, the molar was extracted first, followed by conventional osteotomy preparation and immediate implant placement in the fresh extraction socket.

The primary outcome was implant stability measured using implant stability quotient (ISQ). Secondary outcomes included implant positioning and deviation from the furcation area, surgical time, and postoperative pain.

Inclusion criteria

• Age 18 years or older.
• Both sexes.
• Cooperative patients likely to maintain good dental health.
• Adequate bone height for placement of implants with a minimum implant length of 7 mm.

Exclusion criteria

• * Patients who had undergone previous extraction of all remaining teeth.

• Implant placement in both healed bone and extraction sites during the same procedure.
• Presence of any local or systemic factors contraindicating oral surgery.
• Poor oral hygiene.
• Conditions that may complicate wound healing, including uncontrolled diabetes, smoking of 10 cigarettes per day, pregnancy, history of drug or alcohol abuse, and inability or unwillingness to return for follow-up.