When conducting socket preservation simultaneously with tooth extraction

A 51-year-old male patient.

Implant placement is planned for the maxillary tooth #26 area.

Due to inadequate bone on the palatal root side, an extraction was performed with simultaneous socket preservation.

Implant placement was performed after approximately 4 months of socket preservation. Here is a photo of the implant in place.

Implants from Ossteo Bionics, specifically the SB implants, were placed during the procedure.

The implant was placed using a crestal approach in the maxillary area, and BioCrea was used for grafting during implant placement.

This is a post-operative radiograph after the surgery.

The bone density at the time of implant placement was approximately D3.

Here is a brief summary of the implant surgery record I use:

I always make sure to record the bone quality, initial stability, and generally, I note down the expected prosthetic placement date at the time of implant placement.

Here is a photo taken about 3 months after implant placement.

While I don't always measure Ostel values, when measured, they were around 75, and we are currently in the process of starting prosthetic work around the 3-month mark.

There is always a debate about loading time, but Ostel is a reference point and not an absolute rule, it seems.

For cases with favorable initial stability, in the maxilla, waiting around 2 to 3 months and in the mandible, around 3 months before starting prosthetic work is a general guideline. Especially for maxillary cases with bone density around D2 to D3, it might be safer to measure Ostel values if necessary before proceeding with prosthetic restoration.

In my case, depending on the situation such as bone grafting or immediate implant placement, and of course varying based on the specific circumstances, I generally wait for around 4 months before proceeding with loading, following the healing period.

Even if the Ostell reading is high at 1 or 2 months, it doesn't necessarily indicate that biological stability has been fully established. Therefore, I believe that early loading should only be considered in necessary cases to ensure safety.

When locking the impression coping during impression taking, applying excessive force of over 20 N to the impression coping can cause discomfort to the patient and may lead to unstable bone integration, potentially resulting in implant instability. Therefore, applying manual pressure of around 10 N could be a more suitable approach to minimize errors and ensure patient comfort.