Splint or Not
A 54-year-old man is a heavy bruxer. The tooth #15 has fractured mesiodistally asymptomatic for a few years. Recently the crown of #14 implant is loose after 3-year functioning. In fact the abutment (4.5 mm, 10 °) is separated from the implant. The unipost is recemented with bonding. A provisional is fabricated.
When the tooth #15 is extracted, the socket is treated with Metronidazole. Probably a long and large implant will be used (e.g., 7x17 mm, as compared to 6x17 mm at #14). Try to place the new implant as straight as possible so that a straight unipost will be used to reduce the chance of unipost loosening due to long term and heavy mastication. If primary stability is high, splint #14 and 15 provisional. Otherwise make #14 one with full occlusion and #15 one with infraocclusion. Last week root canal therapy was done at #4. If he masticates mainly on the right, the tooth #4 may be prematurely fractured.
If the crestal bone is severely uneven, use a SM implant instead.
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Upper Molar Immediate Implant
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Xin Wei, DDS, PhD, MS 1st edition 06/24/2016, last revision 12/16/2018