Immediate Dental Implant Placement After Atraumatic Extraction of a Mandibular First Molar: A Case Report

Abstract

Non-restorable mandibular molars with compromised coronal structure following root canal treatment pose clinical challenges, especially when located near critical anatomy like the inferior alveolar nerve. This case report describes the immediate implant placement in a 25-year-old female nonsmoker with a fractured, non-restorable tooth #36 due to inadequate ferrule (<2 mm). Cone-beam computed tomography (CBCT) revealed sufficient bone volume (16.5 mm vertical height, 6.0 mm buccolingual width) and a 3 mm clearance from the nerve, allowing for safe implant placement. Atraumatic extraction using mid-root separation preserved socket integrity, while osteotomy preparation engaged basal bone 2.5 mm apical to the socket floor. A 4.6 × 11.5 mm bone-level tapered implant achieved primary stability (40 Ncm torque, ISQ 50) and was restored with a transmucosal healing abutment. This approach minimized trauma, preserved alveolar bone, and ensured favorable soft tissue healing. The case highlights the importance of CBCT-guided planning, biologically respectful extraction, and evidence-based implant protocols—including thresholds for primary stability and subcrestal placement—to achieve predictable outcomes. Immediate implants can be a safe and effective solution in complex posterior mandibular cases when guided by precise imaging and minimally invasive techniques.