Proposal of Classification for Management of Molar Extraction Sockets and Decision Making for Immediate Implant Placement: A Technical Report

In cases where adequate primary stability (PS) is established, the immediate implant placement (IIP) in molar sockets is considered a reliable treatment option that significantly reduces the overall treatment time. Several key factors contribute to the success of IIP in molar sockets, notably the presence of sufficient inter-radicular septa, which is essential for achieving the necessary PS in cases of elongated roots and also preventing buccal plate collapse. Furthermore, the properties of the buccal bone plate (BBP) may have a significant impact on the final morphology of the ridge following the healing period. This technical note aims to offer a classification system for multi-rooted molar sockets, along with treatment guidelines that consider crucial variables such as morphology, biological factors and the mechanical properties of the socket. The prevalent classification of molar sockets documented in the literature is based on the inter-radicular septum. This study introduces a different classification along with treatment recommendations aimed at enhancing the management of multi-rooted molar sockets during IIP. The proposed classification focuses on two critical variables: the presence of inter-radicular septa and BBP, to achieve optimal PS. According to the different conditions of the septal bone and buccal bone plate, the molar socket categorized into four distinct types - Type 1: Intact bony walls with intact septal bone; Type 2: Compromised bony walls while the septal bone remains intact; Type 3: Intact bony walls with a compromised septal bone; Type 4: Both bony walls and septal bone are compromised. This classification is crucial for understanding the structural integrity of molar sockets and guiding appropriate clinical interventions. This biomechanical classification emphasizes the beneficial role of the septal bone, along with the situations of the BBT, in preserving the vascular supply to the buccal plate, thereby reducing the risk of its collapse. This classification serves as a valuable framework for managing sockets during IIP. In all socket types, achieving PS is paramount for successful implant placement procedures.