IS Guides for IBS/Tatum Implants M

After finishing osteotomy with IS guide and Tatum Tapered tap 5x14 mm for 11 mm (gingival level) free hand, a 5x11 mm Tatum implant is placed at #18 with >15 Ncm (Fig.1).  Bone harvested from the site of #18 will be used for #15 sinus lift (Fig.2 * as well as allograft).  By the similar fashion, osteotomy at #15 is finished according to IS drill sequence except underdrilling (4.0x7.3 mm drill with 2 O-rings).  Following use of DIO Sinus Approach Kit and placement of 2 pieces of PRF membrane and mixture of autogenous and allograft for sinus lift, a 4.5x11 mm IBS dummy implant is placed (Fig.2).  With more allograft for sinus lift, a 5x9 mm implant is inserted with >35 Ncm (Fig.3).  At #18 the implant 2.5 months postop (Fig.4) seems ok with removal of the cover screw and placement of a healing cuff.  The implant at #15 appears osteointegrated with sinus lift 2.5 months postop (Fig.5 *).  Half month later, the implant at #18 is tender associated with unipost placement.  The healing abutment returns.  A pair abutment (5.5x4(4) mm; 25 Ncm) is placed at #15.  When the patient returns 7 months postop, BWs are taken to confirm that the abutment at #15 is fully seated, whereas that at #14 is not (Fig.6).  A healing abutment is then placed at #14.  Osteointegration seems to occur at #18; there is no tenderness when a 4.5x3 mm abutment is placed (Fig.7).  Provisional crowns are fabricated at #15 and 18 for progressive loading.   When the patient returns 14 months postop, a 5x4(4) mm hex abutment is placed at #14 with apparent gap between the implant and abutment (Fig.8 (PA) open arrow).  In fact the gap seems to be absent more coronally as shown by bitewings (Fig.9,10 <).  All of the 3 crowns are cemented in situ (Fig.11, 12) although the one at #14 is removed with the abutment for removal of residual cement.  When the latter is re-torqued, the abutment remains completely seated (Fig.12).  However, the implants at #15 and 18 appear to be placed distally with free-end guides (black lines).

Return to Upper Lower Molar Immediate Implant, Trajectory Coronal and Apical Gap in IS implant

Xin Wei, DDS, PhD, MS 1st edition 07/18/2019, last revision 10/20/2020