Osteotomy Using Expanders with Drill

The edentulous area at #14 is moderately atrophic,  After incision, the bone is too hard for #15 blade for bone expansion.  Osteotomy is initiated with 1.2 mm drill, followed by insertion 1.3/2.3 mm bone expander (Fig.1).  Use the same instruments are reused twice to change the trajectory (Fig.2,3).  Finally Lindamann bur is utilized to move the osteotomy distally by ~ 2 mm; bone expansion continues until 2.4/3.7 mm expander for 13 mm with 50 Ncm (Fig.4). The last expander 3/4.4 mm barely enters the osteotomy for 6 mm.  A 3.7 mm drill has to be used for 12 mm before placement of a 4.5x11.5 mm implant with >35 Ncm (Fig.5).  A 5.5x5(3) mm abutment is placed with allograft (<) placed around the implant.  Following suturing, periodontal dressing is applied around the implant.  The abutment dislodges 3 months postop (Fig.6).  Crown is delivered 3 weeks later.  The abutment screw is retightened ~ 2 months later. He is a bruxer. The abutment screw is loose again <2 years post cementation (6 months post #18 screw retightenting and occlusal reduction), probably related to distal implant placement (Fig.7).  

Return to Upper Molar Immediate Implant, IBS, #20, 29, 18

Xin Wei, DDS, PhD, MS 1st edition 06/08/2017, last revision 09/04/2019