Implants or Not

A 22-year-old man presented to clinic 8 years ago with congenital malformation of the 4 lower bicuspids.  LR5 and LL4 had RCT, LR4 had amalgam (Fig.1 A) and LR5 had extraction and implant.  Two years after crown delivery, there is buccal concavity at LR 5 (Fig.2 ^, as compared to * in Fig.1).  Approximately 2 years later, there was abscess at #4 (Fig.3) with root fracture (Fig.4).  The patient wished that the tooth should have been extracted earlier.  Saving the tooth appears to be waste of time.  Later the tooth LL4 was extracted.  The patient will return for LL4 implant consultation.  Severe atrophy at LL4 is expected.  Take photos and PA of the affected area.

If there is enough bone, implant and abutment (tenting effect) will be placed with bone graft and PRF (3-4 tubes).  Make an extended buccal sulcus incision with periosteum underscore and relaxed suturing.

In fact, the ridge is atrophic buccolingually, manifested as low density (Fig.5,6 *).  The bone height is enough to accommodate a 3, 3.5x23 or 3.8x18 mm 1 or 2 piece implant (Fig.7).

Return to Lower Premolar Immediate Implant, IBS

Xin Wei, DDS, PhD, MS 1st edition 10/30/2016, last revision 11/20/2016