3rd Placement (Palatal and Deeper)

Seventeen months post 1st placement (#9 and 10, 16 months post 2nd placement for #10), the patient agrees to have re-treatment.  The implant is loose with fistula (Fig.1).  More importantly it was buccally placed (Fig.2,3).  It is removed easily.  The buccal (B) plate is found to be thin and/or perforated (dashed line; Fig.5a (buccopalatal section of the socket (S))).  Initially the new osteotomy is established in the palatal plate (Fig.5a *), which ends up with perforation (Fig.5b).  Then the osteotomy is initiated in the palatal portion of the existing osteotomy (Fig.4 white circle; Fig.5c red line).  The 1st intraop PA shows that the trajectory (Fig.6) should be adjusted (Fig.7).  There is ~ 8 mm in the new bone, although it is soft (78 year-old lady, heavy smoker, who refuses to quit).  A 3.8x15 mm UF implant is placed (Fig.8).  Clinically it appears that there is no buccal bone support.  After further osteotomy, the implant is placed deeper (Fig.9,10) with placement of a 4.5x4(4) mm abutment.  A splinted provisional is relined and recemented.

Return to Upper Incisor Immediate Implant, IBS, No Deviation Xin Wei, DDS, PhD, MS 1st edition 09/20/2016, last revision 09/03/2020