Longest Implant for Lower Molar

A 58-year-old lady has a long-standing periapical lesion with several episodes of acute infection (Fig.1-3, taken 10, 9 and 2 years ago, respectively).  Explore the socket for size and wall integrity (Clindamycin).  If the bony defect is not extensive, place a longest implant (18 mm bone-level, 20 mm tissue-level) with moderate diameter (5.5, 6 mm).  Otherwise use a shorter, but wider tapered implant (7x12 mm (bone-level), 7 or 8x17 mm (tissue-level)).  If the socket is extremely large, consider using 7 or 8 x20 mm cylindrical tissue-level implant.  Use Bicon 2 mm pilot drill with extension to measure the socket depth and obtain 3-6 mm new bone or until 20 mm (gingival margin).  Take PA.  The 1st option is to use UF 3-4.7x18 mm drills at 50 RPM.  Make sure that the depth is reached (septum crestal level) and check osteotomy wall integrity after each drill.  Then place a 5 or 5.5x16 or 18 mm implant (Fig.6).  The 2nd and 3rd options are shown in Fig.4 and 5.  Due to severe infection and pain, a shorter implant is placed.

Return to Lower Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table) Xin Wei, DDS, PhD, MS 1st edition 07/02/2016, last revision 08/25/2018