Restorative Space

Following tooth extraction, the sockets are thoroughly debrided and packed with Clindamycin gauze (Fig.1: #22,23,26,27).  PA is taken when 1.5 mm pilot drills are placed in the lateral incisor sockets and 2.0 mm in the canine sockets (Fig.2).  Fig.3 shows that 4.5x17 mm tap (T) is placed in the lower right canine region, while 3.5x17 mm one piece implant is placed in the lower right lateral. 

Fig.4 shows a ball abutment (A) is inserted to a 4.5x17 mm tapered implant at the site of the tooth #27.  In fact, the one piece implant (O) deviates distally.  S stands for the original socket.

The distance between the lower left canine and lateral incisor is more acceptable than the lower right one (Fig.5), but the implants are not placed deep enough.

These difficulties are related to limited socket exposure during osteotomy.  The threads of the implants (<) are exposed as early as one week postop (Fig.6) and last 4 months postop (Fig.7).  Immediate difficulty is that a lot of acrylic has to be removed to accommodate the balls.  In one word, restorative space is not wide enough.  Raising flaps with alveoloplasty prior to osteotomy could solve the problems (Fig.4,5).

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Xin Wei, DDS, PhD, MS 1st edition 06/28/2014, last revision 06/29/2014