Septum Shorter Than Expected
Based on CT taken several years (not on the most recently taken PA in Fig.1), initial osteotomy in the septum of the site of #15 with 1.6 mm drill for 7 mm leads to sinus floor perforation (Fig.2). A 5x9 mm dummy implant is placed with <50 Ncm post sequential osteotomy until 4.8 mm Magic Drill (Fig.3). The sinus membrane remains intact; after sinus lift with Vera allograft mixed with autogenous bone, a 5x11 mm IBS implant is placed with < 40 Ncm (Fig.4,5). With collagen plug placed in the apical portion of the palatal socket, more allograft (Fig.6 (BW) *) is placed around the implant and a 6x5.7(3) mm abutment. With more collagen plug placed over the graft, an immediate provisional is fabricated. The implant is loose nearly 2 months postop. After removal of the immediate provisional and abutment, the implant is re-torqued <15 Ncm (implant is placed ~ 1 mm deeper), as compared to >20 Ncm at #14 (without change in depth (3 months postop), Fig.7). The previous mesiobuccal and distobuccal sockets (Fig.7 *) have apparently disappeared. The implant is found to be loose with infection 9 months postop. There is pain when water pik is being used. The implant is removed with abundant granulation tissue; Vanilla/Osteogen graft is placed 10.5 months postop (Fig.8 *). Failure factors include severe preexisting infection, poor oral hygiene and implant surface treatment. Socket preservation should have been done.
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Upper
Molar Immediate Implant, Prevent
Molar Periimplantitis (Protocols,
Table), #3,14,28,
31
Xin Wei, DDS, PhD, MS 1st edition 10/02/2017, last revision 08/20/2019