Uneven Crests

A 39-year-old lady has generalized moderate localized severe chronic periodontitis (Fig.1-4).  She wants to take care of the lower incisors first.  The tooth #24 has been extracted, while #25 is mobile (Fig.4).  If #23 is not affected, two of 1 piece implants (2.5 and 3 mm) are placed at the sites of #24 and 25, respectively (Fig.5).  If the tooth #23 turns to be non-salvageable, two of 3 mm 1 piece implants are placed immediately (Fig.6).  A bridge will be fabricated.  Since the gingiva is thick, ~ 4 mm, implants with 4 mm cuff (pink outline) will be used when the latter are placed at crest level.  The implants can be placed below the distal crests (Fig.4 white arrowheads) and above the mesial crests with bone graft (Fig.7 red circles).  In this way, there will be more implant/bone contact when the length of the implants are the same.  However, the gingival cuff will be shorter (2 mm).  When the implants are not placed too deep, crown/root ratio will be more favorable.  The ratio will improve if longer implants are used (Tatum).  What is the outcome?

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Xin Wei, DDS, PhD, MS 1st edition 05/10/2015, last revision 01/27/2019