Simultaneous Implant Placement and GBR

As indicated by CBCT, the ridge at the site of #19 is pointed (Fig.1).  After regional ridge reduction (Fig.2) and use of 2 mm pilot drill for 8.5 mm, the depth is actually ~ 10 mm.  After sequential osteotomy until 4.3x10 mm drill, the osteotomy is in fact 11.5 mm deep; a 5x11.5 mm implant is placed with <35 Ncm (Fig.3).  Panoramic X-ray shows the implant close to the superior border of the Inferior Alveolar Canal (Fig.4 red dashed line).  The ridge looks wider and more bulging (*) when a 6.5x5.5(5) mm abutment, allograft/Osteogen and Osteotape (GBR) are placed (Fig.5 (lingual) and 6 (buccal)).  Periodontal dressing is then applied.  There is no postop paresthesia.  The abutment dislodges 3 weeks postop.  A healing abutment is placed (6.5x4 mm).  The patient returns for restoration 4 months postop; bone density appears to increase around the implant (Fig.7 arrowheads).  When a 7.5x5(4) mm abutment is placed, there is transient pressure on the gingiva (blanching).  The mesial gingival trough is formed by Diode laser prior to impression.

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Xin Wei, DDS, PhD, MS 1st edition 01/30/2017, last revision 06/04/2017