Introduction
• "Wet Finger" dentists are always challenged by the dichotomy: cost vs outcome.
• Patients measure implant success by how good they look and how long they last.
• Failing molar teeth from perio, endo and fracture is common.
• Failure to replace these teeth places the patient on a downward spiral both socially and functionally.
• The immediate replacement of failing molar teeth with Southern Implant Max implants is quick, cost effective and predictable.
• The initial primary stability of the implants in an extraction site is quite remarkable.
The failing molar is no longer something to stress over. We now have an easy solution for failed molars even upper 2nd molars.
Abstracts from Publications in Peer-Reviewed Journals
1. Surgical protocol and short-term clinical outcome of immediate placement in molar extraction sockets using a wide body Implant
2. A wide-body implant as an alternative for sinus lift or bone grafting
3. Occlusal reconstruction of a collapsed bite by orthodontic treatment, pre-prosthetic surgery and implant supported prostheses. A case report
Full Articles Published in Peer-Reviewed Journals
1. Classification of molar extraction sites for immediate dental implant placement: technical note
2. A wide-body implant as an alternative for sinus lift or bone grafting
3. Surgical protocol and short-term clinical outcome of immediate placement in molar extraction sockets using a wide body Implant
Ten Commandments of the MAX Implant
1. Select for purpose
The original intended purpose of the MAX was to facilitate immediate placement in a molar socket.
It was not designed for delayed placement, as a rescue implant, or any other tooth site. Although they have been used successfully by some of these applications, it is not recommended.
2. Never use in thin biotypes
This is “generally recommended for all implant types, but is especially important in the MAX. Classification of biotypes as “thin” or “thick” is, however, subjective.
The socket should be intact in all four directions. If not, it is best to augment and delay placement.
3. Never attempt a conventional extraction
This is especially true for molars with divergent roots.
Forceps should only be used to assist with initial loosening.
The recommended protocol is to decoronize the tooth separate the roots without removing any interradicular bone, and elevate the fragments.
4. Prepare the site incrementally
Step 1: If there is a sharp intraradicular crest, use a carbide burr to flatten the center to create a wider V-shaped profiel, with the surface lying 4-5mm above the socket apex (depth can be confirmed with a probe).
Step 2: The pilot hole should be offset toward the lingual/palatal and the mesial. the pilot hole is easier to start accurately with a harpoon drill. The location must be accurate before moving to the next drill as it cannot be revised later in the drilling sequence.
Step 3: Decoronize and drill through the tooth roots with 1.2mm diameter twist up to 5-6mm depth. Depth must be correct before moving to the next drill as it cannot be revised later in the drilling sequence.
Step 4: Elevate the roots. The drilling sequence after elevation is:
- 2mm twist drill
- 3.5mm tapered drill
- 4mm spade
- 5mm spade
- 6mm dedicated MAX drill
- appropriate dedicated MAX final drill or tap
5. NEVER engage the buccal wall
Where possible, retain the buccal strut to maintain distance from the buccal face and give the correct implant position. Filling the socket with the implant should be avoided - there should be a jump gap of 1-2mm. For this reason, 6, 7 and 8mm MAX have become more popular and 9 and 10mm MAX are rarely ever used.
With the narrower MAX it is also more feasible to place two adjacent implants.
6. Place to sufficient depth
Platform of the implant must lie at least 1-2mm beneath the lowest point of the buccal wall. Depth must be preplanned and established right at the start of site preparation, as subsequent drills are designed only to widen the site and cannot increase the depth.
7. Verify position before placement
this must be done clinically and radiographically. Using a tap to verify placement gives the added advantage of assessing insertion torque.
8. You will encounter a high resistance torque
Mathematically, torque is proportional to the square of the diameter, so increases exponentially as implant gets wider. Therefore high insertion torques with MAX implants are inevitable and not unsafe. A current study observing the effects of high insertion torques in MAX implants on necrosis has shown excellent clinical and radiographic results at 2-year follow-up with insertion torques of up to 250 Ncm.
9. Close voids and support soft tissue
Use a wide healing abutment and suture to ensure soft tissue support. If there are particularly large voids, these can be filled with e.g. haemostatic collagen sponge, but leaving the clot is preferred by some and equally acceptable.
10. Follow up
Post operative instructions include no rinsing for one week. Follow-up is important not only for the patient but also to contribute to the data and protocol development.
MAX Presentations
In May 2013 Dr Andre Hattingh presented on Southern Implants MAX implants in Australia. He has kindly made a copy of this presentation entitled "Molar Replacement Surgery - Can You Shorten the Treatment Time?" available here in powerpoint format. Please note that the surgical protocol presented in this lecture differs slightly to the protocol presented below (regarding de-coronation of the crown before preparing the intermediary osteotomy).
Webinar: Indication Specific Implants: Immediate Molar Replacement with Ultra Wide Diameter Implants. Presented by Michael J. Will, DDS,MD, FACS in March 2014.
Webinar: Immediate Implant Placement in a Molar Extraction Socket. Presented by Kelly Olsen, DDS in June 2014.
Videos of MAX Cases
These videos showcase a very successful progressive immediate loading technique by Dr Costa Nicolopoulos, interview available here. It is recommended in most cases to practice the delayed loading technique. Case selection is very important for MAX cases, and even more so for immediate load cases.
Product Catalogues
The Southern Implants MAX system is available in three connections.
External Hex - The traditional Branemark tried and true connection, with a standardised hex for simple platform switching and enhanced with three engaging dimples to increase the connections resiliance to torque loading when placed. Full pdf catalogue available here, or online here.
Tri-Nex - Similar to Replace Select tri-lobe but with an internal hex to drive on that is capable of safely transmitting the required torque to place the MAX implant. Full pdf catalogue available here, or online here.
IT - Similar to the Straumann tissue level connection with a taper and octagon. Available via special order in New Zealand, please contact us for further information.
MAX Surgical Protocol
The full MAX surgical protocol including graphics is available here...
If you have any comments or queries please feel free to use the feedback form below...
