Short Statue, Poor Dentition vs. Provisional

A 36-year-old woman (XW) is skinny.  Probably the alveolus is small with soft bone.  Furthermore, her dentition is poor with two nonfunctional lower 1st molars (Fig.1 #19,31).  When a provisional is fabricated for #11 (Fig.2,3 (deep bite)), extra occlusal pressure may be exerted, causing implant failure.  Preventive measures include careful evaluation of the buccal and palatal wall defects after extraction (Clindamycin socket treatment), underprep (Bicon 2 mm pilot drill for 20 mm, 2.5 mm reamer for 17, 3 for 14 and 4.5x20 mm tap), long implant (Fig.4), and ample occlusal clearance when a unipost is placed and a provisional is fabricated.  Since the canine is wide buccopalatally, implant placement does not need to be too palatal.  The buccal margin should be prepared more apically.

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Xin Wei, DDS, PhD, MS 1st edition 05/22/2016, last revision 01/19/2018