MESSAGE BOARD 1 First Immediate Implant Case: Advice Needed A Townie seeks technique advice for a first-time immediate implant cowjo Post: 1 of 71 10/11/2024 I have never placed an immediate implant before, but I think I found a good first case. Patient is a 40-year-old male with a low smile line. Here is my proposed implant site. I am planning on placing a 4.2×13 Implant Direct Legacy3. My current plan is to drill to a 2.8 osteotomy and then place the implant and hope for enough primary stability. I would love to get some advice if this is a solid plan or not. Do you guys think there are enough threads in the bone to get stability? I don't plan to immediately load, but I would like to place a custom healing abutment. Andrew Farkas DDS, DABOI Post: 3 of 71 10/11/2024 In my opinion, an anterior tooth is not a great choice for the first immediate implant case. This is a difficult case that needs to be placed deeper than planned. A shorter implant placed deeper would be my choice, but it's not an easy case. Premolars and molars are easier immediates for me. n cowjo Post: 4 of 71 10/11/2024 n I see what you are saying. I can angle the tip of the implant more buccal to keep it screw-retained. Looking at the scan now I do agree I should make it deeper by 2 mm. The implant tip is 3.7 mm compared to the 2.8 mm osteotomy. I'm worried if I go to my next 3.4 mm drill that it won't be undersized enough and I won't get enough torque. Should I be looking for a more aggressively tapered implant? As far as the initial osteotomy, I will use a pilot NeutrophilOMFS Post: 2 of 71 10/11/2024 My thoughts: That angulation will result in a cement retained crown unless you use an angled screw channel. I think the placement needs to be 2 mm deeper to give more running room and account for some crestal remodeling. If you only make an osteotomy of 2.8 mm, is the apex of the implant narrower than that? If not, the implant will spin and slide buccal. What's your plan for starting the osteotomy? n drill angled toward the lingual slope about 2/3 up the wall and then puncture the cribriform plate a couple millimeters and then re-angle the drill to just inside the incisal edge. n toofache32 Post: 6 of 71 10/11/2024 I would place the platform of the implant where you have it but angle it towards the apex of the original tooth. That would give you a screw channel through the cingulum. And deeper. Don't get caught up on drill sizes because that is a feel of bone density. I take the first 2.0 drill deeper than I expect to need to give me the chance to force the implant in at high torque. Sometimes perforating into the nose. I use JANUARY 2025 | 14 | DENTALTOWN.COMhttps://www.dentaltown.com/messageboard/thread.aspx?s=2&f=123&t=386584&g=1 http://www.DENTALTOWN.COM