Initial osteotomies at the sites of #3 and 4 are parallel immediately post extraction (Fig.1); the buccal plate of the #4 socket is absent (*).

Immediate implants (Fig.3: 6x17 and 4.5x20 mm at #3 amd 4, respectively) obtain insertion torque > 60 Ncm.  Abutments are placed (5x3 and 3.5x3 mm).

The provisional is dislodged 3 months postop because of mobility and extrusion of the implant at #4 (Fig.6 with increased peri-implant space: *). There is no buccal concavity at #4.  After local anesthesia, the implant is retightend until 20 Ncm.  The provisional is recemented.

When the patient returns 3 months post #4 implant retightening, the implant is stable with apparent osteointegration mesially radiographically (Fig.7).  The most coronal distal threads appear not covered by bone (*).  The implant should have been placed more apically 1st and 2nd times, when the buccal plate is missing.

Provisional Without Prep Last Next

Xin Wei, DDS, PhD, MS 1st edition 09/18/2015, last revision 05/20/2018