Adjustments of Position & Trajectory of Osteotomy

Fig.1 shows initial osteotomy of 8 mm in depth at the site of #31.  But it is close to the Inferior Alveolar Canal (Fig.2 red dashed line: its superior border).  If the osteotomy is moved mesially and trajectory tilts distally, a 5x10 mm implant (Fig.2 black area) has the same clearance as the original osteotomy mentioned above.

A second intraop PA is taken with 4.5x10 mm drill in place (Fig.3).  If the same drill tilts distally as the green area indicates, an implant to be placed is most likely level with crest (arrowheads).  In fact the 5x10 mm implant is placed in an ideal trajectory as planned with insertion torque more than 50 Ncm (Fig.4).  Due to bone resorption, a long abutment (6.8x5.5(3) mm) is placed for an immediate provisional (Fig.6 A (taken nearly 3 months postop)).  For the same token, #2 implant should have a long abutment.  There is no bone resorption 2 years 10 months post cementation (Fig.7) or 3 years 3 months post cementation (Fig.8).

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Xin Wei, DDS, PhD, MS 1st edition 10/01/2015, last revision 04/24/2019