Three-dimensional alveolar bone assessment of mandibular molars for immediate implant placement: a virtual implant placement study

BACKGROUND: To elucidate the anatomical features of the mandibular molar region to allow safe immediate implant placement. METHODS: Cone-beam computed tomography images of 150 patients (600 teeth) were reviewed retrospectively. The virtual implants were placed in the mandibular first and second molar region. The anatomic structures of the mandible and inter-radicular septum were both categorized into three types. The relationship between implant and inferior alveolar nerve (IAN), and the horizontal distance from the implant surface to the bone wall were analyzed. Variables were compared using a student’s t-test, or Mann–Whitney U test. RESULTS: Type U (39.0%) and type S (56.0%) were the most common in the first molar, while type U (67.7%) and type M (54.7%) had the highest prevalence rate in the second molar. The mean distance from the level where the virtual implant was completely surrounded by bone to IAN was 7.06 mm. The mean horizontal widths from the implant to the mesial and distal socket wall were 1.59 mm and 1.89 mm. The widths of the inter-radicular septum and the distances from implant to the buccal and lingual plate on different sections were significantly associated with tooth position (P < .05). CONCLUSIONS: In the first molar region, the implant is suggested to be placed in the center of the inter-radicular septum, while in the second molar region, the mesial root socket could be considered. Immediate implant placement in the mandibular second molar sockets shows a high risk of IAN injury, lingual perforation, and inadequate primary stability.