Depth and Position of  Immediate Implant

A 32-year-old man has a residual root at #5 with sufficient bone height (Fig.1).  Depth and position of immediate implant (4.5x20 mm) are to be improved over a previous case (Fig.6,7).  The landmark for the depth of the osteotomy (2 mm pilot drill and reamers) is the papillae, more than 1 mm apical to them.  The drills, taps and implant should be in the middle socket (mesiodistally) and as palatal as possible.  The initial depth of the pilot drill is 14 or 17 mm.  A PA is taken, trajectory is adjusted if needed and the final depth is reached.

Before procedure, take photos to show that the root stump is oval in shape, longer buccolingually than mesiodistally and that the buccal plate is not concave.  Prepare a surgical handpiece in case of sectioning.  If the implant is placed superficial, a short abutment is needed (probably 3.5 or 4 mm in diameter).  Cut a strip of gauze to be used as gingival retraction cord.  After an immediate provisiional is fabricated, bone graft is placed (mixture of autogenous, allograft (if necessary) and Osteogen.  Try to push the graft as buccally as possible (for bulk effect, Fig.7).  Collagen dressing is optional.  Then cement the provisional.

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Xin Wei, DDS, PhD, MS 1st edition 10/12/2014, last revision 01/19/2018