After use of Magic Drills 3.3 mm for 13 mm and 3.8 mm for 11 mm, placement of a 4x11 mm IBS meets resistance because of the dense bone (Fig.5, 6; red dashed line: Mental Loop) with final insertion torque >50 Ncm.  After placement of a 6x4(3) mm abutment, autogenous bone is placed in the remaining shallow sockets.

Impression is taken 3 months postop (Fig.8).  Buccal infection develops 2 weeks post cementation (Fig.9).  When the crown/abutment is removed, there is no residual cement.  The implant threads can be felt through the fistula.  After soft tissue debridement and copious irrigation, Arestin is placed in the fistula.  It appears that early periimplantitis develops because of the preexisting buccal furca lesion and failure to place the implant deep.  The implant will be placed deep after loosening a little (since there is apical space (Fig.8 white line)) or removed, truncated at the apex and placed lower than the buccal crest.

Dense Bone Last Next

Xin Wei, DDS, PhD, MS 1st edition 03/09/2017, last revision 02/25/2018