Close Call

A 42-year-old man has poor dentition with missing multiple teeth.  He was a smoker.  After smoke cessation, two implants are placed at the sites of #3 (6x17mm) and 19 (5x14mm) (Fig.1,2).  It does not sound great to place #3 implant close to a potential infection site (#5, Fig.1).  But the latter is asymptomatic.  Four months post #3 implantation, he returns with pain in the upper right sextant (Fig.3).  The tooth #18 appears to shift mesially (Fig.4).  To place a crown over #19 implant, the mesial surface of the crown of #18 has to be trimmed.  What cannot be done associated with #18 shifting is food impaction between #17 and 18 (Fig.8).  Clinical exam reveals crack of the tooth #4.  Immediate implant is planned.  Is it too close to the infection site?

Due to finance, no treatment is provided to #5 (Fig.5 (4.5x14 mm tap),6 (4.5x14 mm implant)).  PA (Fig.7) is taken 8 months postop.  The crowns at the sites of #3 and 4 have been cemented for 9 months. 

It appears that the crack root of #5 does not have bacteria or that there is no direct communication between #4 and 5 for bacteria to travel.  The radiolucency is away from the implant site.

Return to Implant Placed Next to Infection Site or Not, Upper Bicuspid Immediate Implant, Posterior Immediate Provisional

Xin Wei, DDS, PhD, MS 1st edition 05/19/2013, last revision 11/05/2014