When is a Long Abutment Needed?

A 46-year-old lady has generalized moderate localized severe (Fig.1 (panorex) #31) chronic periodontitis.  Surprisingly there is sufficient bone height (Fig.1 white dashed line: upper border of the Inferior Alveolar Canal).  The gingiva is quite thick (Fig.2 (PA) arrowheads: gingival margin).  In order to prevent thread exposure associated with immediate implant, a bone-level implant will be placed (Fig.3 5.3x8 mm; green lines) with a long abutment (5.8x5.5 mm (black lines) (6 mm cuff; red lines)).   Initial osteotomy depth is between 14 and 17 mm.  Insert a parallel pin and take the 1st intraop PA.  Use reamers to enlarge osteotomy and collect autogenous bone.  A drill with a stopper (5x8mm) will be used prior to placement of the implant mentioned above.  Since the opposing is a removable partial denture, an immediate provisional at the site of #31 should be safe to be fabricated.  Bone graft will be placed to cover the exposed implant surface.  The remaining gap will be filled with collagen dressing and the provisional.  A temporary abutment is the other option.  The shoulder of the temporary abutment will be subgingival to long extent.  Is the plan well executed?

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Xin Wei, DDS, PhD, MS 1st edition 04/07/2015, last revision 11/14/2018