When a 5x11.5 mm implant is placed at the site of #19 with 50 Ncm (Fig.5 I), there is minimal bone left distal to the tooth #20 (small *).  Mixture of autogenous bone and allograft (.5-2 mm, Fig.6 large *) is placed in the remaining bony defects before and after placement of a 7.5x4(4) mm abutment (A).

The bone graft (Fig.7 large *) remains in place 4.5 months postop.  More amazing is that there is formation of new bone distal to the tooth #20 (small *).  The patient does not complain of tenderness of this premolar any more.

Bone density around the implant increases 8 months postop (3.5 months post cementation, Fig.8 *), although there is tenderness buccal to #19.  Amoxicillin is prescribed.  In fact the implant should have been placed deeper, equicrestal or slightly subcrestal distal (Fig.9,10).

Bone Loss Involving Neighboring Tooth Last Next

Xin Wei, DDS, PhD, MS 1st edition 12/04/2019, last revision 12/05/2019