Long-Cuffed Abutment is Needed

When the patient returns for treatment, the implant at #19 is mobile with tenderness (without purulence, Fig.1).  She finally agrees to have CT taken (Fig.2,3 (coronal section (L: lingual))).  The implant is removed after several carpules of cocktail anesthetics for infiltration and one carpule for block.  Osteotomy is initiated in the mesial slope of the defect (Fig.2,4).  The advantage of immediate implant re-placement is wide bone at the intended area (Fig.3). After change in trajectory (compare Fig.4 (4x11 mm dummy implant) and Fig.5), a 4.5x9 mm IBS implant is placed with insertion torque of 50 Ncm (Fig.5); with Osteogen plug placed in the distal defect, allograft (*) is placed immediately distal to the implant.  With the longest cuff available (4 mm), the margin of the abutment (4.5x4(4) mm) is equi-crestal (>).  When the 9 mm long implant is placed deep, the coronal threads of the implant are distally exposed (Fig.6 between arrowheads) less than those of the 11 mm one placed superficial (Fig.2).  Intraoperative socket hemorrhage is controlled by packing gauze saturated with Epinephrine 1:50,000.  The patient chooses not to take Medrol Dose Pack for postoperative edema.  She removes periodontal dressing herself prematurely.  The socket wound dehiscence is noted the first postop visit (7th day).  Fig.7 is taken 9 days postop before re-suturing.  The patient insists on removing the implant with dull pain.  Three months 10 days postop, she returns with loss of the abutment and a fistula (Fig.8).  In fact there is bone formation distal to the implant.  Torque wrench has to used to remove the implant.

Return to Lower Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table), Course 1 2, Buccal Placement

Xin Wei, DDS, PhD, MS 1st edition 06/19/2017, last revision 10/01/2017