Keep Roots for Osteotomy

A 40-year-old man with #18 missing and #31 residual roots just fractures the tooth #20 (Fig.1).  After discussion, he agrees to have implants at #18 and 20 first.  To prevent buccal drifting of osteotomy and implant at #20, the implant will be placed lingual, but it does not contact the lingual plate (Fig.2-4).  Traditionally, the whole tooth needs to be extracted (Fig.5,6) before initial osteotomy (Fig.7 red).  The latter has tendency to drift buccal because of the lingual slope (Fig.7 arrow).  To prevent the drifting, the crown of the tooth is removed (Fig.8).  A guide is fabricated with 12 mm offset so that after bone trimmer (Fig.9 pink), the following drills have more contact with metal sleeve.  Furthermore the drills will have less chance of buccal shifting because of the presence of the root.

To prevent buccal or lingual drill drifting over the pointed ridge at #18 (Fig.10 v), flap will be raised to make sure the ridge top is flattened before osteotomy.

Return to Prevent Molar Periimplantitis (Protocols, Table) No Deviation No Antibiotic Surgery
Xin Wei, DDS, PhD, MS 1st edition 06/16/2020, last revision 07/27/2020