18 mm Bone-level Implant

A 59-year-old woman had root canal therapy for the tooth #19 10.5 years ago (Fig.1 (red dashed line: the superior border of the Inferior Alveolar Canal).  Two years later there was apparent periapical radiolucency with the distal root (Fig.2 *).  The tooth remains asymptomatic until the last six months.  There are 2 fistulae associated with the tooth: mesiolingual and buccal furca.  Radiogra-phically, there are 2 radiolucent lesions: mesial and apical to the mesial root (Fig.3 *).  If a 16 mm implant is placed, there will be approximately 5 mm apical bone (Fig.4); 7 mm for a 18 mm implant.  The bone height is 25 mm (Fig.6).  Therefore, once initial osteotomy is established with a 13 mm long drill with PA confirmation, the osteotomy is extended to its depth with 1.5x21 mm drill (Fig.5).  After socket treatment with Metronidazole gauze with Epinephrine (1: 50,0000), take PVS impression of the socket to catch the large mesial defect.  A fair amount of allograft and Osteogen is expected.  It has been 9 months since last visit.  Retake PA before surgery.  If the mesial defect enlarges, start osteotomy in the distal slope of the septum.

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Xin Wei, DDS, PhD, MS 1st edition 03/05/2017, last revision 03/04/2018