Maxillary Posterior Implants in Hard Bone

A 53-year-old man had the teeth #3 and 5 extracted 4 years ago (Fig.1).  Oral hygiene in the missing tooth area was poor with calculus deposited on the buccal surface of the tooth #2 (Fig.2 C).  Before (Fig.2) and after (Fig.3) calculus removal, the upper right arch appears to be mis-aligned. 

Fig.4-6 are mirror views of the region, 7.5 months post extraction and 2.5 years from now.  The tooth #29 is missing, while the tooth #30 has mesially tilted and shifted (Fig.5) and slightly supraerupted (Fig.6).  Knowledge of the local occlusion should help fabrication of a provisionals at #3 and 5.  In fact the left side of the mouth has been restored (1,2).

His bone is wide (Fig.4) and hard.  If the keratinized gingiva is wide in the edentulous areas, use 3 (from DIO 1-piece implant kit) and 4 mm tissue punches for access.  Initial depths for #3 and 5 are 8 and 14 mm.  Insert parallel pins to check bite and take X-ray for trajectory.  Use reamers or SM drills (if the bone is too hard) to finish osteotomies.

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Xin Wei, DDS, PhD, MS 1st edition 11/22/2015, last revision 02/27/2018