2 mm 1-Piece Implant at Knife-edged Ridge
After extraction of the teeth #23 and 25, the sockets are detected to be small (#23) and non-existent (#25). Osteotomy at #25 is initiated with 1.2 mm drill flapless. It feels that the buccal plate is perforated. An incision is made (Fig.1). With better visibility, the initial osteotomy at #25 is extended with change in trajectory to avoid accentuating the buccal perforation (Fig.2). An angled 3 mm 1-piece implant is expected. A straight dummy one is tried first, but it cannot be placed deep (Fig.3, underprep, narrow space). A 2.5x14(2) mm 1-piece implant is placed instead with mildly compromised trajectory (Fig.4,5).
With confirmation of the extremely narrow ridge at #23 (Fig.4) and flattening the ridge, osteotomy is initiated (Fig.5). Initially a 2x14(4) mm implant is placed partially with apparently fracturing the cortical bone. After repeated drilling, the implant loses stability. After placing bone graft in the osteotomy, the implant achieves primary stability (Fig.6); bone graft is placed (*). Following suturing, periodontal dressing is applied.
In fact the implant at #23 is loose 1 month postop. The patient will return 2.5 months post implant removal. With incision and ridge reduction, a 2.0 or 2.5 mm 1-piece implant should be able to be placed, since hemorrhage should be less than the previous surgery. Splinting the provisional must be helpful. The tooth #26 will be tested for necrosis (percussion and pulpal test).
Return to Lower Incisor Immediate Implant, IBS Xin Wei, DDS, PhD, MS 1st edition 07/17/2017, last revision 06/02/2018