Immediate Implant in a Large Defect

A 58-year-old man has chronic periodontitis and occlusal trauma.  The mobility of the tooth #2 is more mesiodistal than buccopalatal (Fig.1,2).  It appears that bone height is more than 20 mm.  After extraction and socket treatment with Metronidazole, the initial osteotomy depth will be 20 mm with 2 mm pilot drill, followed by 2.5-3 mm reamers.  Insert 4.5x20 mm tap.  If the latter is stable, take PA or Pan for depth confirmation.  Implants that may be used include 6x20, 7 or 8x17 mm Tatum tapered or cylindrical and 5 or 5.5x18 mm UF.  If the distal surface of the tooth #3 is denuded, use Endogain for surface treatment before bone graft.  Collagen plug, Osteoplug and Collagen dressing should be ready.

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Xin Wei, DDS, PhD, MS 1st edition 12/21/2015, last revision 01/08/2016