Continuing Education

Course Number: 170

Immediate Dental Implant

Placement: Technique, Part 2
Authored by
John Cavallaro, DDS, and Gary Greenstein, DDS, MS

Upon successful completion of this CE activity 2 CE credit hours may be awarded

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contact their state dental boards for continuing education requirements.

Immediate Dental Implant
Placement: Technique, Part 2
Effective Date: 2/1/2014 Expiration Date: 2/1/2017
LEARNING OBJECTIVES
After participating in this CE activity, the individual will learn:
• Indications and contraindications for immediate implant
placement.
• Technique variations that are employed when placing
immediate implants in different areas of the mouth.
ABOUT THE AUTHORS
Dr. Cavallaro is a clinical associate
professor of prosthodontics at the College
of Dental Medicine, Columbia University,
NY, He maintains a private practice in
surgical implantology and prosthodontics
in Brooklyn, NY. He can be reached via
e-mail at the address docsamurai@si.rr.com.
Disclosure: Dr. Cavallaro reports no disclosures.
Dr. Greenstein is a professor in the
department of periodontology at the
College of Dental Medicine, Columbia
University, New York, NY. He maintains a
private practice in surgical implantology
and periodontics in Freehold, NJ. He can
be reached at ggperio@aol.com.
Disclosure: Dr. Greenstein reports no disclosures.
INTRODUCTION
Immediate dental implant placement, whereby the implant
is inserted directly after a tooth is extracted, has gained
widespread acceptance based on a high survival rate.1,2
However, placement of immediate implants in different
regions of the mouth and under diverse conditions can be
challenging. Part one of this 2-part article addressed
important clinical issues relevant to immediate implants.
Part 2 provides practical clinical information for positioning
1
Continuing Education
immediate implants in different sections of the mouth, with
a focus on Type 1 extraction sockets.
POSITIONING IMMEDIATE IMPLANTS BY REGIONS
OF THE MOUTH
Jumping Distance
The jumping distance is a term that refers to the gap between an
immediately placed implant and the bone’s ability to bridge the
gap.3 Usually, if the gap is less than 2.0 mm, it will fill with bone
without bone grafting.4,5-7 Others suggest that an even greater
distance can heal without any osseous augmentation.8,9
Maxillary Anterior Teeth—An osteotomy is created on
the palatal aspect of the socket (Figures 1a to 1e). It is
advisable to take a side cutting (Lindemann) drill and create
a ledge in the palatal bone two thirds the distance from the
crest of bone to the apex. This ledge is used as a purchase
point to place twist drills. It may be useful to enter the bone
at an angle with a twist drill and then straighten it up as the
osteotomy is created. Ideally, the implant will be positioned
so that incisal edges of the mandibular teeth are aiming at
the cingulum of the future anterior restoration. Maxillary
teeth protrude at about 110°; thus it is necessary to drill the
osteotomy in a manner that positions the implant to restore
the desired tooth position and contour. It is advisable to
keep the implant slightly lingual in the socket and it should
not touch the buccal plate of bone. The horizontal biologic
influence of the implant should be respected to avoid
inducing buccal alveolar bone loss.10 As previously
indicated, implants should be placed one mm subcrestally
as viewed from the labial osseous crest. In addition, to
avoid an implant being pushed buccally upon insertion, it is
a good idea to reshape (remove) a small amount of palatal
bone at the crest prior to implant placement.
Maxillary Bicuspids—In the first bicuspid site, if the
furcation bone interferes with selecting an ideal osteotomy
location, it should be removed. If the furcation bone is thick,
then the osteotomy can be initiated there. Usually, the buccal
socket of a 2-rooted bicuspid is not a good location for an
implant. It is too far to the buccal, and often there is a labial
concavity of the alveolus. Thus, this location should be
avoided because it will provide poor esthetics, and drilling
an osteotomy in this site can result in labial plate
perforation. The osteotomy should be drilled relatively
 Continuing Education

Immediate Dental Implant Placement: Technique, Part 2

straight and the implant
should be directed at the a b
buccal aspect of the lingual
cusp of the opposing arch.
Occasionally, the palatal
root of a 2-rooted premolar is
in a favorable location
(relative to adjacent teeth) to
Figure 1a. Occlusal view of an extraction socket Figure 1b. Cone beam (CB) cross-sectional view
be used as a site for (No. 9). The root has been removed atraumatically of site No. 9. Note the appropriate entry point for
osteotomy preparation and without damage to the labial bony plate. the osteotomy (yellow arrow).
implant insertion (Figures 2a
to 2c). The clinician must c d e
recall that as the position
(mesiodistal and bucco-
lingual location that the im-
plant’s platform occupies
within the bone) deviates
from the center of the tooth Figure 1c. Clinical view of Figure 1d. Clinical occlusal view of Figure 1e. The healing
to be restored, then implant seated within graft material placed around a healing abutment has been
prepared osteotomy with abutment. It provides support for the removed and a contoured
additional sink depth to adequate sink depth labial soft tissue. provisional crown has been
provide for running room to (approximately 3 mm apical to placed (out of occlusion).
the labial aspect of the free
create a proper emergence gingival margin of the
adjacent teeth) to provide a
profile of the restoration proper emergence contour of
must be created. the provisional restoration.
Maxillary Molars—The
osteotomy should be drilled in the furcation bone, and when attain mechanical retention against the buccal—palatal or
inserted, the implant may be totally or partially surrounded by mesial—distal aspects of the alveolus. Other times, the
bone. As long as primary stability is attained, the socket will fill furcation bone is not adequate in subantral height for a dental
with bone and the implant will integrate circumferentially. implant, and a transcrestal sinus floor elevation needs to be
Sometimes it is necessary to use a large-diameter implant to performed. In unusual situations when there is minimal bone,

a b c

Figure 2a. Clinical occlusal view of the Figure 2b. The implant is inserted into the Figure 2c. Labial view of restored tooth No.
socket of a maxillary premolar (No. 12) palatal socket of tooth No. 12. 12 at 3 years post-restoration.
immediately postextraction. The palatal
socket is within the confines of the lingual
surfaces of the adjacent teeth.

2

Immediate Dental Implant Placement: Technique, Part 2
but the palatal root alveolus is adequate in height to retain an
implant, it can be used. However, caution must be exercised
not to perforate through the alveolus. If the palatal root is used,
tilt the implant to the center of the osteotomy. Furthermore, if
the palatal root is too far lingual, it should not be employed
because it will create poor positioning of the implant and result
in an unsatisfactory prosthesis. Keep in mind that the alveolar
bone in a healthy situation is 2 mm apical to the cemento-
enamel junction (CEJ). Therefore, it is probable that the
furcation bone is apical to the buccal and lingual osseous
crest. This usually does not present a problem because the
buccal and palatal walls resorb to a small degree. However, if
the walls are very thin, they may resorb several millimeters. If
the furcation bone is many millimeters apical to the buccal and
lingual crests of bone, the implant platform can be placed
several millimeters supracrestally with respect to the level of
the furcation bone.
Mandibular Incisors—The osteotomy can be drilled
straight down the alveolus and the implant should tilt toward
the cingulum of the maxillary opposing tooth. Alternately,
the cingula of the adjacent teeth can provide a visual cue,
or surgical guides can be employed. Note that due to the
shape of the mandible in the incisor area, despite loss of
bone around the roots of teeth, the mandibular bone
actually becomes thicker toward the buccal as drilling
proceeds apically (Figures 3a to 3d).
a b
Figure 3a. CB cross Figure 3b. Clinical view of 2
section of planned implants placed into the fresh
immediate implant in extraction sockets of Nos. 23 and
the mandibular lateral 26. They are inserted slightly to the
incisor position. Note lingual of center buccolingually, but
that the abutment within the confines of the cingula of
tool depicts the the adjacent teeth.
trajectory of the
implant passing
through the cingulum
area of the existing
tooth.
Continuing Education
Mandibular Bicuspids—The length of immediate
implants needs to be carefully assessed due to the location
of the mental foramen. It is coronal to the apex of the first
and second bicuspids, respectively, 38% and 25% of the
time. Therefore, it cannot be assumed that an implant can be
placed that is as long as a bicuspid root.11
Mandibular Molars—After a mandibular molar is
extracted, an implant can be placed in the furcation bone.
Usually, the bone is not thick enough to encompass the
implant circumferentially. Often only the buccal and lingual
aspect of the furcation bone stabilizes the implant.
Alternately, the implant can also be placed into the mesial
or distal alveolus, but the implant should be directed to the
center of the edentate area and aimed at the buccal aspect
of the lingual maxillary cusp. Similar to maxillary molar
implants, when the implant is placed into the furcation
bone, it may be several millimeters apical to the buccal and
lingual osseous crest. The gaps around the implant can be
allowed to fill with a clot or the areas can be bone grafted.
When furcation bone is not available to provide primary
stability, there are implants that are referred to as “rescue
implants” that are very wide and can be used in the man-
dibular alveolus (Figure 4). These implants achieve primary
stability by engaging the buccal and lingual plates of bone. As
always, implant placement must be restoratively appropriate,
or a delayed protocol should be used.
c d
Figure 3c. Definitive PFM restoration Nos. 23 Figure 3d. Periapical radiographs of
to 26. the definitive prosthesis (Nos. 23 to 26)
supported by immediately placed,
immediately restored implants at 5
years after completion (nonocclusally
loaded immediate provisionalization).
Note excellent bone levels.
3

Immediate Dental Implant Placement: Technique, Part 2
ISSUES RELEVANT TO IMPLANT PLACEMENT
Bone Grafting
Various graft materials including autogenous bone, demin-
eralized freeze dried bone, and hydroxyapatite have been
used in gaps around immediately placed dental implants with
and without barriers, and have achieved defect resolution.12 At
present there is no one graft material that appears to be
superior to all others. If a biomaterial is placed in the gap, some
collagen material (eg, CollaCote [Zimmer Dental]) can be
placed on top of the material to inhibit exfoliation of the material
before a fibrin clot forms.
As indicated, gaps < 2 mm heal spontaneously without graft
material. Deproteinated bovine bone mineral (DBBM) is the
most commonly used biofiller in recent studies, and it was
employed alone and in conjunction with resorbable and
nonresorbable barriers.2 However, a possible explanation for the
high use of DBBM is that in Europe, human allograft material is
not allowed to be used in humans. Additionally, a biomaterial
may be placed to preserve soft-tissue contour even if it
provides no enhancement to osseointegration of the implant.
Prior Position of Roots May Be Poor Guide for Implant
Placement
If possible, implants should be placed in their ideal locations to
enhance prosthetic reconstructions. Pertinently, if roots of
extracted teeth are not in the best position for a future
prosthesis, the root socket should not be used as a guide to
create osteotomies. If using the socket as a guide will create a
nonoptimally positioned implant, either start a new osteotomy
or use a side cutting drill to extend the root socket to the correct
position for implant placement.
Technique for Placing Implants When Dilacerated
Roots Are Present
If dilacerated roots are present, it is difficult to initiate an
osteotomy along a sloping bony wall. Instead, take a pilot drill
and approach the socket in the appropriate place (often just
prior to the dilacerations) at a 90° angle. Enter the bone and
then create a purchase point for subsequent drills.
Immediate Placement if There Is a High Smile-Line
In the esthetic zone, if there is a high smile-line, immediate
placement should only be attempted if the following criteria
4
Continuing Education
Figure 4. Wide body
dental implant
immediately placed into
the socket of a
mandibular first molar
(No. 30). The implant
engages the buccal and
lingual cortical plates
and achieves primary
stability even though
there are remaining
gaps mesially and
distally.
are present: periodontal health, no recession, thick biotype,
keratinized gingiva, and an intact buccal bony plate of bone.
The most critical facet is the buccal plate of bone. The CEJ is
normally 2 mm apical to the gingival margin. If the bone is 3
or 4 mm from the gingival margin, it increases the risk of
potential recession. Immediate placement when there is a
defective bony plate runs the possible complication of
recession that may expose implant threads.
Concerns About Recession
Extrusion of Teeth—If a tooth needs to be removed and
replaced with an immediate implant, consideration needs to
be given to the amount of soft-tissue recession and bone loss
that occurred. In this regard, a hopeless tooth may not be a
useless tooth. It can be used via orthodontic extrusion to help
correct soft- and hard-tissue deformities. Orthodontic
extrusion can coronally advance the tissue approximately one
mm per month.13,14 If there is 3 mm or more of recession,
consider orthodontic extrusion.
Biotype—Lee et al15 concluded that a thin biotype
predisposes individuals to recession and loss of papillae. In
this regard, Kan et al16 reported that a thin biotype (probe is
visible when placed in the sulcus) in the esthetic zone
demonstrates 0.7 mm more recession post-healing than a
thick biotype (probe not visible when placed in the sulcus)
after implant placement. In the esthetic zone, if the biotype is
thin, place the implant more palatally and a little more apically.
Recession at Implant Site—If it is noticed that the buccal
gingiva is several millimeters more apical than the gingival
margin of adjacent teeth, there are several techniques that
can be used to augment the gingiva at the time of immediate
implant placement: (1) place a short healing abutment on the
implant and advance the flap to cover the abutment, and (2)
place a cover screw in the implant and cover it with a
 Continuing Education

Immediate Dental Implant Placement: Technique, Part 2

Table. Conclusions and Guidelines for Treating the Buccal Gap

After Immediate Implant Placement20-30
1. Avoid elevating a labial flap when placing implants in the esthetic zone, thus decreasing the risk of
recession.20-23 Raise a lingual flap if additional access for visualization is needed.
2. Gaps < 2 mm wide will usually heal spontaneously without placing a biomaterial.24 If a biomaterial is
inserted in the gap which is less than 2 mm, the data indicate that there will be crestal bone loss, but the
horizontal width (contour) will be maintained better.25-27 In the esthetic zone, it may be advantageous to
graft the buccal gap; at a minimum it will help support the soft tissue.
3. It has been suggested that it is better to leave the gap uncovered, thereby retarding the connective tissue and
epithelium from interfering with initial population of the site with bone progenitor cells.28
4. The implant should be inserted 2 mm from the buccal plate to circumvent encroaching on the buccal
bony plate, thereby contributing to resorption.29
5. Insert implants one mm below the crest of bone to account for crestal bone loss.25,30
6. Biomaterials can be inserted without a barrier, thus avoiding flap elevation. But, if there is a bone
dehiscence, it may be useful to place a barrier, and this would necessitate elevating a flap in order to
achieve wound closure.
7. With a flapless approach, it was suggested that overfill of the gap with deproteinated bone helps support the
soft tissue and reduces recession when it is done in conjunction with an abutment and temporary crown.28 This
statement is based upon a recently completed study.

connective tissue graft or other soft-tissue biomaterial and CONCLUDING REMARKS

advance a flap over it. If a clinician is in doubt abut the
potential effectiveness of these procedures in a given
situation, then a delayed protocol should be selected.
Provisionalization for Immediately Placed Dental
Implants
It is recommended that an insertion torque of 30 to 40 Ncm
be attained when placing an implant if an abutment and a
provisional crown are to be inserted.17 The provisional
prosthesis should not be in occlusion for single tooth
replacements. If multiple implants are placed or the
prosthesis turns the corner of the arch, or if it is a full arch
provisional, then occlusion can be restored. If a permanent
abutment is inserted, it may not have to be subsequently
removed (avoids disrupting the junctional epithelium), and
this may help decrease recession.18,19
Placement of immediate implants is a predictable
procedure, and attention to detail is essential to ensure
success. The Table20-30 lists guidelines to enhance
successful placement of immediate implants in Type I
sockets. Management of atypical situations outlined in this
paper should enhance results and help avoid esthetic
problems.
Often, sockets, adjacent or opposing teeth can provide
adequate visual cues for implant placement. However,
surgical guides can be used to facilitate precise placement
of implants.31 This is particularly true if multiple implants
are placed or deviations from optimal anatomy are
apparent. In this regard, contemporary implant
planning/anatomy software can greatly simplify these
surgical interventions.32-34

5

Immediate Dental Implant Placement: Technique, Part 2
REFERENCES
1. Lang NP, Pun L, Lau KY, et al. A systematic review on
survival and success rates of implants placed
immediately into fresh extraction sockets after at least
1 year. Clin Oral Implants Res. 2012;23(suppl 5):39-66.
2. Ortega-Martínez J, Pérez-Pascual T, Mareque-Bueno
S, et al. Immediate implants following tooth extraction.
A systematic review. Med Oral Patol Oral Cir Bucal.
2012;17:e251-e261.
3. Botticelli D, Berglundh T, Buser D, et al. The jumping
distance revisited: an experimental study in the dog.
Clin Oral Implants Res. 2003;14:35-42.
4. Paolantonio M, Dolci M, Scarano A, et al. Immediate
implantation in fresh extraction sockets. A controlled
clinical and histological study in man. J Periodontol.
2001;72:1560-1571.
5. Caneva M, Salata LA, de Souza SS, et al. Hard tissue
formation adjacent to implants of various size and
configuration immediately placed into extraction
sockets: an experimental study in dogs. Clin Oral
Implants Res. 2010;21:885-890.
6. Covani U, Cornelini R, Barone A. Bucco-lingual bone
remodeling around implants placed into immediate
extraction sockets: a case series. J Periodontol.
2003;74:268-273.
7. Botticelli D, Berglundh T, Persson LG, et al. Bone
regeneration at implants with turned or rough surfaces
in self-contained defects. An experimental study in the
dog. J Clin Periodontol. 2005;32:448-455.
8. Botticelli D, Berglundh T, Lindhe J. Hard-tissue
alterations following immediate implant placement in
extraction sites. J Clin Periodontol. 2004;31:820-828.
9. Tarnow DP, Chu SJ. Human histologic verification of
osseointegration of an immediate implant placed into a
fresh extraction socket with excessive gap distance
without primary flap closure, graft, or membrane: a
case report. Int J Periodontics Restorative Dent.
2011;31:515-521.
10. Rodríguez-Ciurana X, Vela-Nebot X, Segalà-Torres M,
et al. The effect of interimplant distance on the height
of the interimplant bone crest when using platform-
switched implants. Int J Periodontics Restorative Dent.
2009;29:141-151.
11. Fishel D, Buchner A, Hershkowith A, et al.
Roentgenologic study of the mental foramen. Oral
Surg Oral Med Oral Pathol. 1976;41:682-686.
6
Continuing Education
12. Chen ST, Wilson TG Jr, Hämmerle CH. Immediate or
early placement of implants following tooth extraction:
review of biologic basis, clinical procedures, and
outcomes. Int J Oral Maxillofac Implants.
2004;19(suppl):12-25.
13. Salama MA, Salama H, Garber DA. Guidelines for
aesthetic restorative options and implant site
enhancement: the utilization of orthodontic extrusion.
Pract Proced Aesthet Dent. 2002;14(pt 2):125-130.
14. Buskin R, Castellon P, Hochstedler JL. Orthodontic
extrusion and orthodontic extraction in preprosthetic
treatment using implant therapy. Pract Periodontics
Aesthet Dent. 2000;12:213-219.
15. Lee A, Fu JH, Wang HL. Soft tissue biotype affects
implant success. Implant Dent. 2011;20:e38-e47.
16. Kan JY, Rungcharassaeng K, Lozada JL, et al. Facial
gingival tissue stability following immediate placement
and provisionalization of maxillary anterior single
implants: a 2- to 8-year follow-up. Int J Oral Maxillofac
Implants. 2011;26:179-187.
17. Chung S, McCullagh A, Irinakis T. Immediate loading
in the maxillary arch: evidence-based guidelines to
improve success rates: a review. J Oral Implantol.
2011;37:610-621.
18. Abrahamsson I, Berglundh T, Lindhe J. The mucosal
barrier following abutment dis/reconnection. An
experimental study in dogs. J Clin Periodontol.
1997;24:568-572.
19. Abrahamsson I, Zitzmann NU, Berglundh T, et al. The
mucosal attachment to titanium implants with different
surface characteristics: an experimental study in dogs.
J Clin Periodontol. 2002;29:448-455.
20. Brownfield LA, Weltman RL. Ridge preservation with
or without an osteoinductive allograft: a clinical,
radiographic, micro-computed tomography, and
histologic study evaluating dimensional changes and
new bone formation of the alveolar ridge. J
Periodontol. 2012;83:581-589.
21. Job S, Bhat V, Naidu EM. In vivo evaluation of crestal
bone heights following implant placement with
‘flapless’ and ‘with-flap’ techniques in sites of
immediately loaded implants. Indian J Dent Res.
2008;19:320-325.
22. Fickl S, Zuhr O, Wachtel H, et al. Tissue alterations
after tooth extraction with and without surgical trauma:
a volumetric study in the beagle dog. J Clin
Periodontol. 2008;35:356-363.

Immediate Dental Implant Placement: Technique, Part 2
23. Barros RRM, Novaes AB Jr, Papalexiou V. Buccal
bone remodeling after immediate implantation with a
flap or flapless approach: a pilot study in dogs.
Titanium. 2009;1:45-51.
24. Chen ST, Buser D. Clinical and esthetic outcomes of
implants placed in postextraction sites. Int J Oral
Maxillofac Implants. 2009;24(suppl):186-217.
25. Chen ST, Darby IB, Reynolds EC. A prospective
clinical study of non-submerged immediate implants:
clinical outcomes and esthetic results. Clin Oral
Implants Res. 2007;18:552-562.
26. Araújo MG, Wennström JL, Lindhe J. Modeling of the
buccal and lingual bone walls of fresh extraction sites
following implant installation. Clin Oral Implants Res.
2006;17:606-614.
27. Caneva M, Botticelli D, Pantani F, et al. Deproteinized
bovine bone mineral in marginal defects at implants
installed immediately into extraction sockets: an
experimental study in dogs. Clin Oral Implants Res.
2012;23:106-112.
28. Tarnow D. Immediate vs. delayed socket placement: what
we know, what we think we know and what we don’t
know. Lecture presented at: American Academy of
Periodontology; November 14, 2011; Miami Beach, FL.
7
Continuing Education
29. Evian CI, Waasdorp JA. Evaluating extraction sockets
in the esthetic zone for immediate implant placement.
Compend Contin Educ Dent. 2011;32:e58-e65.
30. Araújo MG, Lindhe J. Dimensional ridge alterations
following tooth extraction. An experimental study in the
dog. J Clin Periodontol. 2005;32:212-218.
31. Greenstein G, Cavallaro J. The relationship between
biologic concepts and fabrication of surgical guides for
dental implant placement. Compend Contin Educ
Dent. 2007;28:196-203.
32. Giordano M, Ausiello P, Martorelli M, et al. Reliability
of computer designed surgical guides in six implant
rehabilitations with two years follow-up. Dent Mater.
2012;28:e168-e177.
33. Abboud M, Wahl G, Guirado JL, et al. Application and
success of two stereolithographic surgical guide systems
for implant placement with immediate loading. Int J Oral
Maxillofac Implants. 2012;27:634-643.
34. Platzer S, Bertha G, Heschl A, et al. Three-
dimensional accuracy of guided implant placement:
indirect assessment of clinical outcomes. Clin Implant
Dent Relat Res. 2013;15:724-734.
 Continuing Education

Immediate Dental Implant Placement: Technique, Part 2

POST EXAMINATION INFORMATION POST EXAMINATION QUESTIONS
To receive continuing education credit for participation in 1. If the jumping distance is _____, usually it will fill
this educational activity you must complete the program with bone without bone grafting.
post examination and receive a score of 70% or better. a. < 2 mm.
b. 2 to 3 mm.
Traditional Completion Option:
c. 3 to 4 mm.
You may fax or mail your answers with payment to Dentistry
Today (see Traditional Completion Information on following d. 4 to 5 mm.
page). All information requested must be provided in order 2. The buccal socket of a 2-rooted maxillary bicuspid is
to process the program for credit. Be sure to complete your usually not a good location for an implant. It is too
“Payment,” “Personal Certification Information,” “Answers,” far to the buccal.
and “Evaluation” forms. Your exam will be graded within 72 a. The first statement is true, the second is false.
hours of receipt. Upon successful completion of the post- b. The first statement is false, the second is true.
exam (70% or higher), a letter of completion will be mailed c. Both statements are true.
to the address provided. d. Both statements are false.
Online Completion Option: 3. With respect to maxillary molars, alveolar bone in a
Use this page to review the questions and mark your healthy situation is:
answers. Return to dentalcetoday.com and sign in. If you a. At the level of the cemento-enamel junction (CEJ).
have not previously purchased the program, select it from b. 2 mm apical to the CEJ.
the “Online Courses” listing and complete the online c. 4 mm apical to the CEJ.
purchase process. Once purchased the program will be
d. 6 mm apical to the CEJ.
added to your User History page where a Take Exam link
will be provided directly across from the program title. 4. With respect to mandibular bicuspids, the mental
Select the Take Exam link, complete all the program foramen is coronal to the apex of the first bicuspid:
questions and Submit your answers. An immediate grade a. 25% of the time.
report will be provided. Upon receiving a passing grade, b. 30% of the time.
complete the online evaluation form. Upon submitting c. 38% of the time.
the form, your Letter of Completion will be provided d. 45% of the time.
immediately for printing.
5. To account for crestal bone loss, implants should be
General Program Information: inserted:
Online users may log in to dentalcetoday.com any time in a. Level with the crest of bone.
the future to access previously purchased programs and b. One mm below the crest of bone.
view or print letters of completion and results. c. 2 mm below the crest of bone.
d. 3 mm below the crest of bone.

6. After a mandibular molar is extracted, an implant can

be placed in the furcation bone. Usually the bone has
adequate thickness to encompass the implant
circumferentially.
a. The first statement is true, the second is false.
b. The first statement is false, the second is true.
c. Both statements are true.
d. Both statements are false.

8

Immediate Dental Implant Placement: Technique, Part 2
7. To avoid inducing recession in the maxillary esthetic
zone, it is preferable to do the following:
a. Avoid raising a buccal flap.
b. Extrude teeth.
c. Place bone grafts to a crestal level.
d. Remove abutments and replace several times.
8. Orthodontic extrusion of a tooth can coronally
advance the tissue approximately____:
a. One mm a week.
b. One mm a month.
c. 2 mm a month.
d. 3 mm a month.
9
Continuing Education
9. In the esthetic zone, if the biotype is thin, place the
immediate implant:
a. More buccally and more apically.
b. More palatally and less apically.
c. More bucally and a little less apically.
d. More palatally and a little more apically.
10. It is recommended that an insertion torque of _____
be attained when placing an implant if an abutment
and provisional crown are to be inserted.
a. 20 to 30 Ncm.
b. 30 to 40 Ncm.
c. 40 to 45 Ncm.
d. 45 to 50 Ncm.
 Continuing Education

Immediate Dental Implant Placement: Technique, Part 2

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