One Piece Implant or Onlay Graft?

A 48-year-old lady requests fixed prosthesis at the site of #7, which is atrophic (Fig.1 CT coronal section), 2.5 mm wide (Fig.2).  It appears that 2.5x12 mm one piece implant is an option (Fig.3, red circles: particulate graft).  The entrance point of osteotomy should be lingual (Fig.2').  As the smallest pilot drill penetrates the cortex (Fig.2" black triangle), the trajectory should be changed using surgical stent (S) and a finger on the labial plate (yellow) as guides.  In this way it is easy to restore, since the abutment of 2.5 mm 1 piece implant is straight (Fig.3).

In contrast, a 3 mm one piece implant has 15º abutment (Fig.4) so that the implant can be placed in a more anatomic position.  It appears that buccal bone graft is necessary (red lines).  Since #2 and 31 are missing, onlay graft can be harvested from #31 edentulous area (Fig.5; A: axial; C: coronal; S: sagittal section).

Which procedure is chosen?

Return to Upper Incisor Immediate Implant Atrophic Ridge

Xin Wei, DDS, PhD, MS 1st edition 11/27/2014, last revision 08/05/2018