Intraop Subgingvial Prep

Preop PA shows the thick gingiva at the site of #15 (Fig.1 double arrows).  A 6x14 mm tissue-level implant is expected to be placed subgingival (Fig.2). 

Clinically, the edentulous area looks narrow buccolingually (Fig.3).  When flaps are raised, the ridge is wide enough to hold a 6x14 mm implant (Fig.4).  Primary stability is achieved partially due to bone expansion.  The preop narrow ridge appearance is caused by the thick gingiva.  Intraop PAs are taken, but lost digitally.  Because of the thick gingiva (Fig.4 G), the margin of restoration has to be prepared intraop (Fig.5 (illustration) red lines) after placement of an abutment (pink area).  An immediate provisional (green outline) has to be fabricated to keep the gingiva from growing toward the margin.

The patient returns asymptomatic 2 weeks postop; the immediate provisional is in place (Fig.6,7 P) with distal healing wound (^).  The provisional is retained by 6x14 mm implant (I, insertion torque > 60 Ncm) and 5x5 mm abutment (A).

Return to Upper Molar Immediate Implant, Posterior Immediate Provisional

Xin Wei, DDS, PhD, MS 1st edition 06/16/2015, last revision 07/06/2015