a 50-year - old male patient presented with a history of moderate periodontitis with grade 2 mobility of most of the mandibular [ figure 1 ] teeth and his profession dictated for an immediate solution . atraumatic extraction of 41 42 43 44 45 51 52 53 54 55 56 57 58 was carried out under local anesthesia [ figure 2 ] using lignocaine with adrenalin . atraumatic extraction using periotomes without excessive enlargement of the socket was done in order to preserve the alveolar bone which is very important to the success of immediate implant placement . the implant size is determined by the help of the root length and diameter also with conventional methods [ figures 3 and 4 ] . the sockets were debrided and 3i biomet implants 4 mm  11.5 mm were placed in the extracted sockets of 45 55 12 22 [ figures 5 and 6 ] . a pre - fabricated mandibular provisional denture with a soft reline was placed [ figure 7 ] . pre - operative view showing the mandibular teeth extracted teeth ( above ) measuring the root length to synchronize with the implant placement of implants ( above ) osstell to check the stability of the implant post - operative orthopantamogram with implants insertion of provisional denture success in dental implants is a result of certain level of competence of the dentist along with use of products that ensure predictable functional balance between technology and biology , which predicts a lifelong functional and esthetic solution for the patient . the advent of calcium oxide anodized titanium surface treated implants has shown to accelerate and enhance the osseointegration of the implant in the living bone .
this case describes extraction of teeth in the mandibular arch , i.e. , 41 42 43 44 45 51 52 53 54 55 56 57 58 ( grade two mobility ) , followed by immediate placement of four dental implants ( 3i biomet ) , two in the 45 55 region and two dental implants in 12 21 region . a prefabricated provisional mandibular denture was immediately placed . the purpose of immediate placement was to aid the patient resume his professional duties the next day itself along with esthetic and functional comfort , psychological well - being and most importantly preserving the remaining tissue in a healthy condition .