Limited Height

After extraction of the mesioangular tooth #17, initial osteotomy at #18 is 11 mm in depth with sudden empty feel (without pain with infiltration anesthesia); when a parallel pin is inserted, it goes down more than expected (Fig.1).  Subsequent osteotomy is strictly controlled at the depth of 11 mm for 2.5 and 3.0 mm reamers.  When 3.5 and 4.0 reamers are being used for ~ 9 mm, pain is confined to the coronal portion of the osteotomy, apparently associated with infection from the socket of #17 or from the distal apex of the tooth #19 (scaling & root planing done earlier).  After addition of local anesthetic (infiltration), a 5x11 mm tap is inserted (Fig.2).  With sufficient clearance from the Inferior Alveolar Canal (Fig.1-3 red dashed line), block anesthesia is administered.  A 5x11 mm Tatum implant is placed with >50 Ncm (Fig.3).  A 4.5x5 mm abutment is placed to increase retention of periodontal dressing.  Impression is taken 4 months postop (Fig.4).  The tooth #19 is symptomatic 7 months post #18 cementation.

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Xin Wei, DDS, PhD, MS 1st edition 11/09/2017, last revision 10/24/2018