Septal Bone Inter-ference

Implant placement with guide at #28-30 is smooth, but abutment placement at #30 is in-complete in spite of use of 5.5 and 6.0 mm profile drills, probably related to inter-ference from the septal bone (Fig.1 *).  Switch to a narrower abutment with longer cuff after reuse of the profile drills does not help; there is a vertical gap between the abutment and implant (Fig.2 ^), whereas there is a horizontal gap between them in Fig.1.  The defect between the implants of #29 and 30 is filled with sticky bone, followed by PRF.  The wound is sutured with 4-0 PGA and perio-dontal dressing.  The incom-pletely seated abutment should be retightened or removed ~ 1 month postop when the socket heals to prevent bone loss.  Three and a half months postop, a 4.5x5.5(5) mm cemented abutment is placed and torqued to 30 Ncm at #28 after removal of the healing abutment (Fig.3).  At the same time, the cemented abutments at #29 and 30 are removed for cleaning and then re-placed and torqued.  Note the complete seating of the abutment at #30, as compared to Fig.2.  Since the abutment at #29 (5.2x4(3) mm) is subgingival mesially with possible biologic width violation (close to bone graft, Fig.3), it is later changed to 5.2x5.5(4) mm one.

Return to Prevent Molar Periimplantitis (Protocols, Table) No Deviation 12,18-20
Xin Wei, DDS, PhD, MS 1st edition 02/25/2020, last revision 01/08/2021