Implant in Narrow M-D Space
A 42-year-old lady lost the tooth #30 at the age of 16-17. The mesiodistal space is narrow. It appears that a 3 mm 1-piece implant is appropriate (Fig.1). If the buccolingual width is reasonable and the keratinized gingiva is wide, use 3 mm tissue punch for access.
In fact the keratinized gingiva is not wide. An incision is made for access. The buccolingual width is ~ 6 mm. A 1.2 mm pilot drill is used for initial osteotomy at the depth of 12 mm (Fig.2 (red dashed line: the superior border of the Inferior Alveolar Canal)). Enamel-plasty (arrowheads) have been done to increase M-D space. A 3x14 mm bone-level implant is placed with insertion torque of ~ 30 Ncm (Fig.3). After further distal enamel-plasty, an immediate provisional is delivered.
There is no bone resorption 4 months postop (Fig.4). Bone density around the implant increases 8 months post cementation (Fig.5). The gingiva is healthy nearly 10 months post cementation (Fig.6).
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Implant & Ortho
Xin Wei, DDS, PhD, MS 1st edition 11/16/2015, last revision 07/23/2017