Limited Bone Height

The tooth #18 of the 35-year-old man is found to have mesiodistal fracture (Fig.1).  There are two fused sockets: mesial (M) and distal (D) (Fig.2).  Osteotomy is initiated in the mesial wall of the mesial socket (Fig.3 (red line: superior border of the Inferior Alveolar Canal)), as planned.  Later osteotomy is established in the mesial socket as shown by a 4.5x17 mm tap for 14 mm with stability (Fig.4).  Finally a 6x14 mm tissue-level implant is placed with low insertion torque (30 Ncm) because of limited native bone height (Fig.5).  Perfuse hemorrhage also contributes to surgical difficulty.  After placement of bone graft (Fig.6 *) and a short abutment (5x3 mm, A), an immediate provisional is fabricated to keep the graft in the sockets.  In 3 months, the bone graft and native bone become less distinguished (Fig.7, 7').  Impression is postponed because of local poor oral hygiene around the provisional.

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Xin Wei, DDS, PhD, MS 1st edition 04/13/2017, last revision 01/19/2018