Osteotomy As Mesial As Possible

A 62-year-old man will return for #19 immediate implant (Fig.1,2).  These X-ray films were taken 4.5 years ago.  Chronic periodontitis has been getting worse since.  He requests treatment because of mobility.  It is assumed that there is more bone loss.  Pack 2% Xylocaine/1:50,000 Epinephrine gauze in the socket for hemostasis and further debridement.  Start osteotomy mesial to the septum if it is present, since there is tendency to place osteotomy too distally.  It is difficult to correct it.  Initial depth will be 10 mm.  Use Tatum tap prior to placement of SM implant (5.3x10 mm).  Bone density is high in this patient when the implants were placed in the lower anteriors and the upper right.  In fact the bone is so dense that 2.5 mm reamer cannot remove bone.

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Xin Wei, DDS, PhD, MS 1st edition 12/05/2015, last revision 12/08/2015