What to Do Next?

A 75-year-old lady has poor dentition.  When she returned for #25 crown recementation, she requests implant placement at the site of #24, which is loose.  It appears that the latter is traumatized due to lack of posterior support (#31 perio/trauma disease; #18,19 missing).  The original treatment plan is to place an implant at the site of #18 and fabricate a 3-unit bridge connecting osteointegrated implant at the site of #20 (provisionalized).  When the implant was placed at the latter site, the bone was found to be soft.  It is apparent that more implants are needed.  Every edentulous space needs an implant.  Additionally, clinical exam shows that the ridge at #18,19 is narrow.  When the implants at #18,19 are placed, they are to be splinted to that at #20 and restored immediately.  Surgical and restorative stents are required.  Preop PA should be taken for bone height measurement.

Last visit, the tooth #24 was adjusted so that it received less occlsual contact.  If the treatment does not help, an immediate implant will be placed with immediate provisionalization.  Even if the provisional is stable with immediate reline, temporary cementation is mandatory.  Our experience tells us when the provisional becomes loose early postop, the bone graft gets lost.  Make sure that the immediate provisional is locked in!  If the tooth #24 needs immediate implant, it will be 2nd case of the control group of the antibiotic study.

After occlusal adjustment of the lower anterior region, what happens next?

Return to Lower Incisor, Bicuspid, Molar Immediate Implant

Xin Wei, DDS, PhD, MS 1st edition 08/09/2015, last revision 12/26/2018