Control Position and Size of Immediate Implant of Upper Central

A 35-year-old lady has multiple restorations and 3 missing posterior teeth.  The tooth #8 with a short post fractures equigingival (Fig.1 ^).  After delivery of a 2nd baby, she decides to have an immediate implant for the central incisor.  Clinically, the root stump looks wide before re-cementation.  Our 1st option is to place 4.5x14 mm bone level implant, followed by a temporary abutment (Fig.2).  The immediate provisional will be fixed with a screw.  After extraction, measure the gingival depth.  Start osteotomy with a 2mm pilot drill in the palatal slope.  The initial depth will be 14 mm (gingival margin).  Check the position and trajectory prior to the final depth of 17 mm.  Insert a short or regular parallel pin for occlusion and a marked one for PA.  Continue osteotomy with reamers until 3 mm (depth less than 17 mm, under prep).  Use Tatum tapered tap 4.5x20 mm less than 17 mm (under prep) to test stability.  If it is good, place the bone level implant.

If it is not good, extend the osteotomy 20 mm deep, followed by reamers and the 4.5x20 mm tap and place a 4.5x20 mm tissue level implant (Fig.3).  If the corresponding tap is not stable, consider using a 5x20 mm implant.

The extraction may turn out to be difficulty; prepare a surgical handpiece.  When taking intraop PAs, place the sensor parallel to the neighboring teeth.  The PA in Fig.1 was not taken properly (not parallel).  Use the blue sensor holder, which is more stable.  Let the patient hold the holder in place, in the middle of the edentulous region.

Take photos prior to surgery.  The patient did not brush the area well because of the loose crown.  The gingiva is erythematous and edematous around #7 and 8 crowns.  Photos are taken to show the infection, the root stump, and buccal plate (chin up).  Boley gauge is used to measure the root dimension after extraction.

Return to Upper Incisor Immediate Implant Xin Wei, DDS, PhD, MS 1st edition 07/01/2015, last revision 10/14/2018