Immediate Implant Placement Through Inter-Radicular Bone Drilling Before Versus After Roots Extraction in Mandibular Molar Area (A Randomized Controlled Clinical Trial)

Placement of immediate implant in mandibular molar area is considered a great challenge, due to the difficulty of implant bed preparation in the presence of interradicular bone septa. Therefore, this study introduces a simple technique for implant bed preparation. Objectives: This study aimed to compare clinically and radiographically the effect of performing two different surgical approaches for implant bed preparation. Materials and Methods: A randomized, controlled clinical trial was conducted on twenty six adult patients equally divided between a study group; where an immediate implant was installed following an innovative drilling protocol through drilling in the inter-radicular bone preceding molar extraction and a control group; where an immediate implant was installed conventionally after molar extraction. Clinical evaluation included assessing implant stability quotient (ISQ) at base line and after 6 months. While radiographic evaluation was done through periapical X-ray and CBCT to assess the implant position and marginal bone loss around the installed implants at baseline and after 6 months. Results: Clinical results revealed that there was no statistical significance difference in mean average ISQ between both groups at base line and after 6 months. Regarding the radiographic results the study group showed that the paralleling pin was more centrally oriented within the inter-radicular bone in comparison to control group. Concerning the marginal bone loss there was no statistical difference between the two groups. Conclusion: The implant bed preparation before roots extraction allows optimal positioning and angulation of the immediate implant in mandibular molar area, thus enabling ideal future prosthesis.