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?
Lower Molar Immediate Implant
Xin Wei, DDS, PhD, MS 1st edition 04/07/2015, last revision 11/14/2018