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