Implants in Narrow Crest by Resection
The ridge between the teeth #19 and 22 is narrow. After resectioning the crest at the sites of #20 and 21 for 3-4 mm (Fig.2 *), the crestal width increases to approximately 5 and 4 mm, respectively. It appears that width may not increase substantially if resection continues. The plan is to use 1 piece implants to reduce postop bone resorption. Initial osteotomy is finished with 1.5 and 1.2 mm pilot drills at the depth of 12 mm (Fig.2). Since there is 4-6 mm clearance from the underlying Inferior Alveolar Canal, the depth increases to 14 mm.
Fig.3 shows that while the 1.2 mm drill remains at #21, the osteotomy at #20 is finished with a 2.5 mm drill. It seems that the crest cannot hold too big an implant.
After placement of 3x14(4) and 2.5x14(4) mm 1-piece implants at the sites of #20 and 21, allograft and Osteogen are to be placed around the defect area (Fig.4 *). These implants oppose an upper removable partial denture, although the patient plans to change to implant supported restoration in the future. Splinted provisional is fabricated at #20 and 21 immediately. The lower removable restoration has turned into one fixed one.
There is small degree of bone resorption between the implants 3 months postop (Fig.5 arrowhead) with the provisional in place (*). Six months later, the tooth #19 needs an implant.
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Premolar,
Arch Immediate Implant,
Posterior Immediate Provisional,
Chinese
Xin Wei, DDS, PhD, MS 1st edition 01/04/2016, last revision 09/18/2017