A 6x14 mm implant (Fig.5 I) and a 5x3 mm abutment (A) are placed.  After abutment height adjustment, an immediate provisional is fabricated.  Allograft with Osteogen is placed in the remaining sockets and gaps.  Insertion torque of the implant is > 56 Ncm.  The mesial crest is low in density (*).

Three months post cementation (10 months postop), the patient complains of gingival bleeding while masticating.  There appears bone loss mesially (Fig.10).  The gingiva appears erythematous around the implant.  Water Pik is recommended.  It is better not to process for final impression if there is minimal sign of infection. 

In fact the oral hygiene improves by brushing.  Six months later, the gingiva is healthy without symptoms, although the mesial bone loss persists with seemingly mesial implant thread exposure (Fig.11 <).  Bone loss is more severe in the proximal area.  There are 4 potential solutions: place implant low, pack more bone graft and remove the immediate provisional once the socket has heals.  The implant should be smaller so that it does not compress the crestal bone, which is more likely resorbed under insertion pressure.  There is no bone loss 17 months post cementation (Fig.12).  The patient reports that he has to keep cleaning well to prevent discomfort locally.  Clinically, the gingiva is healthy around the implant crown.

Socket Seal Last Next Xin Wei, DDS, PhD, MS 1st edition 08/14/2015, last revision 09/28/2019