Second Implant Surgery
Because of back pain, the 45-year-old man requests less implants (#7 and 13) in the second surgery than the previous one (#9-11, 15).
After extraction of the labioincisally displaced #7 (Fig.1, Metronidazole), place either 1 or 2- (Fig.2) piece implant. For the latter (bone density 200-800 units), prepare cemented or angled abutments with 5 mm cuff. Use a crown form for provisional (single unit).
As to #13 placement, remove the provisional at #9-11 (save) and try in a surgical stent (upper left quadrant). Since the ridge at #13 is narrow, #15 blade is required. The incision may have to be extended to #15 mesial for bone graft. Finally a splinted provisional will be fabricated from #9 to 15.
In fact the buccal plate feels to be perforated when 2 mm initial drill is being used probably at the deepest area of the concavity shown in Fig.2 (near B). The trajectory is adjusted and the osteotomy is enlarged by 3 mm drill for 13 mm (Fig.3). When a 3.8x13 mm implant is placed (50 Ncm), an angled abutment is used (Fig.4, 4.5x15°(A)5 mm). As planned, a 3.8x13 mm implant is placed at #13, while bone graft is placed mesial and palatal to #15 implant. No provisional is fabricated from #9 to 15 due to time limitation and lack of parallism between the abutments.
Return to Upper Arch Immediate Implant, IBS, #2,3,5
Xin Wei, DDS, PhD, MS 1st edition 03/19/2017, last revision 10/06/2017