Limited Clearance

The sites of osteotomies at #18 and 20 are decided by the surgical stent (Fig.1).  A 4x14 mm implant is placed at the site of #20 (Fig.2),  and a 5x14 mm one at #18 (Fig.3) with primary stability.  When 3 mm long abutments are placed for an immediate provisional (Fig.4 A), there is no or limited clearance with the opposing dentition (Fig.5).  In spite of the fact that the implants are placed deeper, the abutments and the opposing supraerupted teeth #13 and 15 (Fig.5 arrows) have to be reduced.  Finally the abutment at #18 has to be removed.  No provisional is fabricated.  Periodontal dressing is applied around the abutment at #20 and the adjacent teeth.  It appears that the tissue-level implant is not suitable for the 2nd molar with limited vertical clearance.

There is bone loss at #18 3.5 months postop with mild purulent discharge from the gingival sulcus (1 month post healing cuff placement, Fig.6).  After heavy abutment and the tooth #15 reduction, the provisional FPD has to be made to increase vertical height.

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Xin Wei, DDS, PhD, MS 1st edition 06/06/2016, last revision 09/19/2016