Small, Long Implant Easy for Buccal Plate Repair

The buccally-displaced lower right central incisor (Fig.1 #25) appears to have premature contact (arrow) with the opposing one (#8 with root canal therapy and post).  The buccal fistula of the upper central incisor (Fig.2 *) seems to be less severe than the swelling (arrowheads).  When the crown is removed, the root has a crack line buccally.  Post root extraction, the buccal defect is found to be confined coronally (Fig.3 green area; black line: crestal bone).  Initial osteotomy is 16 mm apical to the palatal crest (~ 4 mm apical to the socket, Fig.4).  A 3.8x16 mm implant is placed with insertion torque > 35 Ncm (Fig.5).  When the small diameter implant is placed as well as a 4.5x5(3) mm abutment (Fig.6 A), there is >2 mm space buccally (for bone graft: *), considering potentially severe postop bone resorption.  PRF is placed buccally prior to bone grafting.

The patient returns for follow up asymptomatic 3 weeks postop.  The buccal fistula appears to have shrunk (Fig.7).  The gingiva adapts to the immediate provisional.  There is no premature contact between the provisional and the opposing dentition (Fig.8).   The provisional is re-cemented 1 month later.

When he returns for final restoration 7 months postop, the provisional has been recemented in a wrong position with a commercial cement by the patient (Fig.9 *) with associated gingival erythema (Fig.10 (*: retraction cord)).   After impression, the provisional retries in (Fig.11); it appears to be too short as compared to the neighboring tooth.  A buccal apical extension should be fabricated for the final crown.  It is apparently due to the labial margin of the abutment being too coronal (Fig.12).  The abutment should have been changed to the one with longer cuff (4 or 5 mm vs. 3 mm, Fig.14)).  The labial margin should be trimmed more apically with a large diameter (Fig.15 white line).

The patient prefers the small mesial and distal diastemata around the temporary crown at #8 (Fig.16 T) to the large distal one of the crown (Fig.17 C).

The previous socket appears to have been filled with new bone 17 months postop and 8.5 months post cementation (Fig.18 *).  The new bone becomes denser 1 year later (Fig.19 *).  The implant remains in the middle of the alveolus 2 years post cementation (Fig.20,21).  There is no bone loss 4.5 years post cementation (Fig.22).  Two gingival retraction cords are inserted prior to recementation (Fig.23).  The gingiva looks healthy around the crown 4.5 years post cementation (immediate post recementation, Fig.24).  In fact the crown is recemented without reopening the access hole (Fig.25).

Return to Upper Incisor Immediate Implant 15 mm Implant at #13 修复

Xin Wei, DDS, PhD, MS 1st edition 03/28/2016, last revision 06/13/2021