Too Short Implant in the Pontic

The ridge at the pontic is narrow (Fig.1).  Bone expansion starts with 1.6 mm drill at 10 mm (Fig.2).  It is close to the root of the 1st premolar (*).   The trajectory is adjusted; after using 2 mm pilot drill at 14 mm, a parallel pin is inserted (Fig.3).  The trajectory is more or less acceptable.  The osteotomy is expanded until 2.9/3.8 mm expander (overprep).  A 3 mm 15° one-piece implant is not appropriate. When a 3.8x14 mm bone-level implant is placed (Fig.4; apical diameter: 2.4 mm), the insertion torque is 15 Ncm.  The buccal plate concavity appears to have been improved, but the coronal portion of the palatal plate is perforated.  The latter is repaired with bone graft (Fig.5 *) after a healing screw is placed (S).  The suture is placed.

When using bone expanders, the last one should be 2 sizes smaller than the final implant.  In this case, the last expander should have been 2.2/3.0 mm in diameter.  The chance of the palatal plate perforation is reduced with increased insertion torque.  If the insertion torque is too high after using the last expander, the osteotomy site can be expanded with the next sized one (2.6/3.4 mm (Bone Expander Kit)).  The implant seems to have osteointegrated 4 months postop (Fig.7).  Bone density around the implant increases 2 years 4 months post cementation (Fig.8).

Return to Upper Premolar Immediate Implant Xin Wei, DDS, PhD, MS 1st edition 11/23/2015, last revision 08/02/2018