Fractured molar – an immediate transition

BioBrief - GBR around implants

The Situation

This case involves a common dental challenge: a failing mandibular molar with a vertical sub-osseous fracture. Traditionally, replacing such a tooth requires multiple surgical procedures—extraction and regeneration, implant placement, and second-stage exposure—often extending the treatment time to over a year.

The Approach

Atraumatic Tooth Extraction and Socket Preparation

Immediate molar replacement simplifies this process by allowing for a single-stage procedure. First, the fractured tooth is extracted as atraumatically as possible, followed by thorough debridement of the socket to remove any remaining tissue. A channel is then created to allow for optimal implant placement.

Implant Placement and Augmentation

A channel is then created to allow for optimal implant placement. The implant is positioned within the bone channel, ensuring the platform sits just below the socket walls. Achieving primary stability is critical for success.

Bone Grafting and Soft Tissue Management

Any residual gaps in the socket are filled using Geistlich Bio-Oss® Collagen, which is then covered with a collagen matrix, Geistlich Mucograft®. The edges of the matrix are carefully tucked under the gingival margins and sealed with tissue glue to support healing.

The Outcome

This single-stage replacement technique has been proven to be safe, effective, and predictable. The key to success lies in ensuring that the socket is fully degranulated, the implant remains stable, and there is no loading during the early healing phase. A gingiva former is placed immediately instead of a cover screw to support soft tissue healing. The use of Geistlich Bio-Oss® Collagen to fill the residual socket and Geistlich Mucograft® to cover the site eliminates the need for flap advancement, making the procedure less invasive and improving patient comfort.

Keys to Success

• Atraumatic tooth extraction
• Thorough degranulation and debridement of the socket
• Ensuring adequate implant stability
• Positioning the implant platform just below the socket walls
• Using a 4.0 mm gingiva former instead of a cover screw
• Augmenting with Geistlich Bio-Oss® Collagen and covering with Geistlich Mucograft®
• Avoiding implant loading during the early healing phase