Change Trajectory with Intention

When the residual root and periapical lesion at the tooth #4 (Fig.1) are removed (Fig.2), it is a natural tendency to make an osteotomy along the long axis of the socket (Fig.3 red line).  Because of slanted sinus floor, the position and trajectory of the osteotomy are most likely to be shifted distally (arrow) as the osteotomy increases in diameter (Fig.4 red) and an implant is being placed (Fig.5 green).

Ideally the initial osteotomy should be intentionally established more mesially (Fig.6,7).  As a 4.5x17 mm implant is placed, the trajectory seems to be normal (Fig.7,8 (*: bone graft)).  The latter seems to help increase bone density at the crest 5 months postop (Fig.9 arrowheads).  The bone density increases 3 years post cementation (23 years old male, Fig.10 (*), as compared to Fig.9 (5 months postop)).  The gingiva looks ok as well 3 years post cementation (Fig.11).

Return to Upper Premolar Immediate Implant Xin Wei, DDS, PhD, MS 1st edition 07/12/2016, last revision 06/20/2020