Why is optimal emergence profile so important in the molar region?
Great question. We know from clinical studies that sufficient soft tissue thickness around the implant is necessary for minimizing marginal bone loss, but this is often lacking in the molar region. A good amount of soft tissue is important, and that’s what the optimal emergence profile can provide.
The wide, interdental spaces in the molar region do not suit a restoration with a narrow platform, because it can lead to food-trapping, gingival inflammation, and other potential complications with the implant. With a wide-platform implant, the emergence profile more closely matches that of the interdental space, and so it supports long-term soft and hard tissue stability.
What are your main considerations for immediate placement the molar region?
I think we have to understand, first, what the patient’s expectations are. If they’re very demanding and want to have a lost molar quickly replaced, then immediate placement can be a good option as it reduces their time spent without a crown, as well as total chair time. It also prevents the adjacent and antagonist teeth from moving around and being displaced themselves, which can help to reduce further issues later on.
When it comes to indications, I perform immediate placement if there is a good amount of buccal bone and soft tissue before extraction – as a benchmark, at least 3 mm bone and 2 mm soft tissue – and if the extraction is atraumatic.
How do you determine what loading protocol to use in the molar region?
Generally speaking, if there’s a stability level of 50 Newton centimeters or more, then I will conduct immediate loading in the molar region.