No Crestal Bone Resorption Expected
A 75-year-old lady has advanced chronic periodontitis; the tooth #25 has mobility. Immediately post extraction, a 1.2 mm pilot drill is used ~ 14 mm subcrestal (Fig.2), followed by 1.5 mm one at 10 mm deep. Bone density is found to be low. A 3x14 (2) mm one piece implant is placed with insertion torque 35 Ncm (Fig.3); there is no contact of the implant with the distal crestal bone (*, no pressure or tension, probably no resorption later on).
An immediate provisional is fabricated (Fig.4 P); mixture of allograft and Osteogen is placed in the distobuccal socket (gap: *). When the provisional is seated, bone graft is held in place (Fig.5 <). Bone graft will help reduce the chance of bone resorption at the crest.
The last reason for possibly no crestal bone resorption is the immediate implant without flap.
The patient and the implant are doing well 7 days postop (Fig.6). The distal crestal defect has been repaired 4.5 months postop (Fig.7 *), while there is mild mesial bone loss, probably due to pressure when the implant is placed (Fig.3). The papillae look normal (Fig.8). The margin of the provisional is modified so that the gingival margin has a chance to grow coronally (Fig.9 ^).
When the definitive restoration is cemented, the margin is short (Fig.10). Eight days later, the metal exposure is less (Fig.11).
It appears that the crown is dislodged, probably since it was temporarily cemented. Take photos and a PA prior to permanent cementation to show that there is no metal exposure cervically (blow air to remove bubble if present) or there is no bone loss.
Three months after temporary cementation of the permanent crown, the latter becomes loose. Before re-cementation with a permanent cement, a PA is taken (Fig.12); mild bone resorption is noted mesially (*), probably related to X-ray angulation. The tooth #24 has mobility II; the patient wants an implant. After cementation, the labial metal exposure appears to be less than before (Fig.13, as compared to Fig.11). In addition, the occlusal contact of the neighboring teeth, especially #24, is reduced. The mobility of #24 is probably related to lack of posterior support.
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Xin Wei, DDS, PhD, MS 1st edition 11/26/2014, last revision 08/09/2015