Implants in Knifed Edge Crest

One month post #3,4 and 10 immediate implant placement (Fig.1), the patient returns for implant placement in the apparently knifed edge crest between the sites of #4 and 10.  The ridge at #8 looks relatively wider, while the socket of #9 has been healing.  When the flaps are raised, the edentulous area at #6 and 7 is extremely narrow, whereas that at #5 and 8 is approximately 4 mm wide.  To place 2.5x14 mm 1-piece implants at #5 and 8 (Fig.2,3, ~ 35 Ncm), the crest top has to be trimmed at #5.  The next acceptable implant recipient site will be #9, one month post extraction/socket preservation.  A 3x14 mm "dummy" 1-piece bone-level implant, placed at #9, appears to be tilted toward the implant at #10.  After removal of the implant, a 3.5x17 tissue-level implant is placed with intention to correct the trajectory (Fig.4), but it is placed clinically too subgingival for restoration.  When it is being backed up, its stability is compromised.  Therefore, a 3.5x20 mm 2 piece tissue-level tapered implant is placed (Fig.5, 15 Ncm).  With total of 6 implants (Fig.6), a splinted provisional is fabricated with occlusal clearance.

The patient returns for definitive restoration 3 months after the 2nd surgery, 4 months after 1st surgery.  There is no bone loss around the implants (Fig.7,8).  The splinted provisional is in place.  The excess acrylic was used to cover the wound at #9 (Fig.9 *).  The gingiva around the implants appears to be normal (Fig.10).  Due to parallel issue, a bridge is fabricated between #5 and 8, while the rest are single units (Fig.11).

The patient returns for follow up 8 months post cementation.  The gingiva looks healthy (Fig.12-15).  There is no bone loss around the implants (Fig.16-18).

Return to Upper Arch Reconstruction Atrophic Ridge

Xin Wei, DDS, PhD, MS 1st edition 12/01/2015, last revision 08/05/2018