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