Peculiar Bone Loss
The mesial and distal crests of the tooth #19 were even for a 50-year-old man 7 years ago. Three years later, swelling developed around the distal root with bone loss (Fig.2 *). Three months later, localized swelling occurred (Fig.3 *) with oozing. The patient had thrombopenia (platelet 40 K). The tooth was extracted with suture. There is distolingual root tip resorption. Two months and a half later (Fig.4), a 6x17 mm implant was placed (Fig.5). The implant osteointegrated 5 months postop (Fig.6). The distal crest re-appears 5 months (Fig.7), 2 years (Fig.8) and 2 years 8 months (Fig.10) post cementation. At the last appointment, the patient complained of pain and swelling at #30 with mesial bone loss (Fig.10 *), as compared to Fig.9 taken 9 years ago. The mesiolingual pocket is deep. After scaling and Chlorhexidine irrigation, Arestin is locally administered.
It appears that the lower molars have a type of occlusal trauma. There is anterior open bite (Fig.10 double arrows).
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Lower Molar Immediate Implant
Xin Wei, DDS, PhD, MS 1st edition 08/27/2016, last revision 08/27/2016