Under Prep, including Length

A 80-year-old lady has history of osteoporosis, diabetes and hypertension.  The latter two are under control.  She has multiple missing teeth with a lower ill-fitting flipper.  The tooth #8 is non salvageable (Fig.1).  The apical bone does not look dense.

It seems that osteoporotic bone is easy to bleed during osteotomy.  Drop 2% Lidocaine with 1:50,000 Epinephrine liquid into Clindamycin powder.  Use the carpule for infiltration anesthesia, followed by Septocaine if needed.  If pain is severe, start with Mepivacaine, followed by 2% Lidocaine with 1:50,000 Epinephrine.  Dissolve Clindamycin powder a little bit late.  Follow this guideline for every patient, osteoporosis or not. 

Use a 2.0 mm pilot drill for barely 20 mm (Fig.2), since osteotomy is close to the nasal floor (^).  Later use an implant to lift the nasal floor.  Take PA with a parallel pin if necessary.  The depth of 2.5 and 3.0 mm reamers will be 17 and 14 mm, respectively.  Place 4.5x20 mm tap at the depth between 14 and 17 mm or until implant motor stalls.  Use 5.0x20 tap if necessary.

Cone-shaped Osteotape and bone graft (black circles) will be used to rebuild the most likely lost buccal plate as well as the mesial and distal walls.

Make sure to call the patient to bring the flipper.  Advise her not to chew with the anterior teeth after fabricating an immediate provisional.  Take photo preop.

Return to Upper Incisor Immediate Implant

Xin Wei, DDS, PhD, MS 1st edition 07/19/2015, last revision 01/19/2018