Immediate Implants & Cross Bite

A 70-year-old man (CK) requests restoration of the upper arch with implants, because he is not used to a partial denture.   Due to cross bite (Fig.1-3), one less implant can be placed in each of the posterior region (Fig.1, 3).

The patient prefers to have implant placement on the right side first.  The implant at #5 should be placed a little more distal in order to have enough clearance (2-3 mm) between the implants at #5,6 (Fig.4 (thick section), 5 (thin section of CBCT)).  Note the kissing periapical radiolucency at #5 and 6 (Fig.5 *).  After residual root extraction, the sockets will be soaked with 2% Xylocaine/1:50,000 Epinephrine. 

Fig.6,7 are coronal sections of the teeth #5 and 6, respectively.  The buccal (B) plate is completely (Fig.6) or partially (Fig.7) lost.  Osteotape is to be inserted between the buccal gingiva and the implant. 

To avoid or reduce the chance of using an angled abutment at #6, the apical end of the implant should be placed as close to the buccal plate as possible (Fig.8 red arrow).  Compare the angles at the implant crown (Fig.7,8).  Initial osteotomy depth is 17 mm; insert parallel pins and take PA for checking trajectory (Fig.4).  When fabricating provisional crowns, make sure that they are palatal to the lower counterparts (cross bite), both right and left.

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Xin Wei, DDS, PhD, MS 1st edition 11/11/2015, last revision 01/19/2018