Immediate Implant (Moderate Size) in the Middle of the Socket

A 46-year-old lady is a typical dental phobic, but she is reasonable.  Her chronic periodontitis is generalized and severe (Fig.1 3-D image, taken 1 year ago).  An implant has been placed at #6 (healed site).  It fails for the first time, probably due to bone loss after extraction.  Soon after last periodontal maintenance, the tooth #2 develops pain and swelling.  Immediate implant is a must.

The socket is wider buccopalatally (Fig.2 (3-D disto-occlusal view),3 (coronal section)) than mesiodistally (Fig.1,4 (sagittal section),5 (axial section)).  Unless more bone loss has occurred in the last year, a 6x10 mm UF implant is to be placed in the middle of the socket (Fig.6, (soaked with 2% Xylocaine/1:50,000 Epinephrine gauze)) with bone graft to be placed in the buccal and palatal gaps (red circles).  Bone density in the middle of the socket is 550-700 Hounsfield units.  Use RT2 or 2 mm pilot drill to start osteotomy ~ 3 mm.  The largest osteotome is RT4, or largest reamer 4 mm, followed by 4.5x17 mm tap at 14 mm, until 6x17 mm one.  Make sure that the sinus floor is penetrated.

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Xin Wei, DDS, PhD, MS 1st edition 12/09/2015, last revision 12/09/2015