Keep Neighboring Tooth Temporarily as Reference for Implant Placement

A 53-year-old woman has toothache in the upper left sextant.  It appears that the teeth #15 and 16 are non-salvageable due to proximal root caries (Fig.1 *).  The tooth #15 is extracted first and the socket will be packed with 2% Xylocaine, 1:50,000 Epinephrine gauze.  The decay at #16 will be removed to reduce intraop contamination (Fig.3 *), followed by insertion of a piece of gauze (Fig.3 white).  Rounded tapered (RT) osteotomes (Fig.3 red arrow) or drills will be used for sinus lift (Fig.1 ^: sinus floor).  With the 3rd molar temporarily in site, the trajectory of the osteotomy is easily controlled. 

Once an implant is placed at the site of #15, the tooth #16 is extracted (Fig.4).  With a piece of gauze in the implant well, allograft/Osteogen is placed around the implant (Fig.5 red circle), while collagen plug in the socket of #16 (Fig.5 brown) if necessary.  After removal of the gauze from the implant well, an abutment is placed (Fig.5 pink).  More graft is placed around the implant shoulder (Fig.6 white circles).  An immediate provisional at #15 could be extended distally to cover the #16 socket (Fig.7 yellow).  Two weeks later the provisional is modified (Fig.7 grey dashed line) to remove the distal extension.

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Xin Wei, DDS, PhD, MS 1st edition 05/06/2016, last revision 05/26/2019