Where to Start Osteotomy?

A 45-year-old lady (FY) has mild discomfort at #31 (Fig.31).  Periapical radiolucency (Fig.2 arrowheads) is closely associated with the Inferior Alveolar Canal (red dashed line: upper border).  Be careful when removing periapical granulation tissue.  The socket will be treated with Clindamycin.  If there is no severe pain associated with granulation tissue removal, osteotomy can be initiated lingual to the apex.  An implant will be placed along the original long axis of the tooth (Fig.3).  Otherwise, an implant will be placed in the mesial slope (Fig.4); the implant will be 2 mm longer; the upper end should be in the middle of the socket.

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Xin Wei, DDS, PhD, MS 1st edition 09/29/2015, last revision 12/19/2018