Confine Implant in Socket

A 65-year-old woman used to have a long bridge (Fig.1).  First, the portion mesial to #20 was sectioned.  But the remaining portion kept chipping.  RCT was retreated for the tooth #20 as the first step to have separate crowns at #18 and 20 and have a lower partial redo.  Instead a new FPD was done between #18 and 20 in her own country (Fig.2).  Two years later, the tooth #20 became symptomatic with increased pdl mesially (Fig.3*).  Periradicular radiolucency increases in another 2 years (Fig.4).  The apex of the affected tooth (yellow dashed line) is close to the Mental Loop (red dashed line, Fig.1-3).  Although the loop is buccal to the apex of the 2nd premolar, an implant will not extend past the apex to avoid neuropathy (Fig.5).  No Inferior Alveolar Nerve block will be administered.  PA will be taken after pilot drill.  The FPD will be sectioned between #18 and 19.  To compensate for the short length of the implant, try to place a large one as long as the buccolingual bone allows.  Adapt the lower RPD to the immediate provisional, which should be as small as possible, since the retention must be not too high.

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Xin Wei, DDS, PhD, MS 1st edition 06/29/2017, last revision 07/11/2017