Immediate Implant to Replace Failed One

A 59-year-old lady used to have a 3-unit bridge in the upper left quadrant.  A 4.5x6mm Bicon implant (Fig.1 B without extruding into the sinus) was placed in the atrophic pontic area 5 months earlier.  When the abutment (A) was removed, the implant came out.  The osteotomy was processed with a 4.5x14 mm tapered tap, which was unstable.  When a 4.8 mm cylindrical tap was placed (past the sinus floor), it was tight (Fig.2).  A 5x14 mm cylindrical implant (Fig.3 I) was inserted with elevation of the apparent sinus floor (>, no allograft used in case of sinus infection).  Seven months postop, the density of sinus floor increases (Fig.4 <).  The implant is stable and processed for crown (Fig.5 C, different view of the lifted sinus floor (<)).  While sinus floor density is decreasing, the mesial and distal bone density is increasing 6 months (Fig.6), 1 year 6 months (Fig.7) and 3 year 6 months (Fig.8) post cementation.

It appears necessary to engage an implant into the sinus floor for primary stability for a skinny, probably osteoporotic female patient.  The shape and diameter of the implant are also critical.

Implant Fails, Upper Bicuspid Immediate Implant

Xin Wei, DDS, PhD, MS 1st edition 06/20/2013, last revision 12/18/2016