Granulation Tissue in Septal Undercut

As planned, osteotomy starts at #4 prior to #3 extraction (Fig.1,2).  In fact the bone density at the edentulous area is high.  Drills are used to finish placing a 4x17 mm tissue-level implant (Fig.3).

A challenge associated with #3 extraction is large amount of granulation tissue apical to the mesiobuccal root (MB, Fig.2 (inset: red dashed line)).  To remove the granulation tissue (*) apical to the septum (S), the septum between the buccal roots has to be chiseled.  The remaining septum for osteotomy becomes less. 

With proper manipulation, a 6x14 mm implant is placed with primary stability (Fig.3).  The buccal and palatal socket opening is closed with Vera Graft (allograft, Fig.4 *), which is in turn covered by an immediate splinted provisional.     No gap exists 7 months postop (Fig.5,6).  Return to Upper Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table), IBS Xin Wei, DDS, PhD, MS 1st edition 09/26/2017, last revision 04/24/2018