Abstract

Immediate implant placement in posterior molar extraction sites presents clinical challenges due to complex multi-rooted anatomy and limited interradicular bone. The Natural Tooth Surgical Stent Technique, uses retained tooth structure as a natural surgical stent, facilitating precise osteotomy and implant placement in a single session. This case report describes the management of a non-restorable right mandibular first molar with a separated endodontic instrument and apical perforation but no active infection or periodontitis. Immediate implant placement using the NTSS technique was performed with successful primary stability and osseointegration. Clinical and radiographic follow-up at 6 months showed stable peri-implant bone and excellent prosthetic outcomes. This report discusses the surgical and prosthodontic considerations, advantages of the NTSS technique, and its role in immediate implantation protocols supported by current literature.

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