Graft Bone Contributes to Stability

Osteotomy shows two layers of bone.  The first one feels slightly less dense than the normal bone (Fig.1 above the red dashed line), while the second one is extremely hard (3-4 mm in depth).  For the last 1.5 mm of the osteotomy, the 4.5 mm drill has to be withdrawn for bone shaving removal before finishing the osteotomy.  In all the graft bone contributes to implant stability (insertion torque > 50 Ncm).  At least the implant is surrounded by the bone with less likelihood of developing periimplantitis.  As usual, there is clearance from the Inferior Alveolar Canal (Fig.2 yellow dashed line).  After quick surgery, the patient wonders why he does not get a provisional.  The advantage of the latter may reduce the chance of shifting of the neighboring teeth (with increased pdl, Fig.2).  In fact he requests final restoration in a month.  Some of my patients travel a lot.  Miao afraid of dentistry.  But after #30 implant placement with guide, she is fearless.  A permanent crown was delivered in 2 months. Two or 3 months later she returned for #14 guide.  Mr. Zheng has the similar situation.  He will stay in his home country for 2 months.  I want to satisfy him although I have not promised to.  Do you  have any suggestions? 

In fact the patient returns for impression 3 months 23 days postop; there is no bone loss at the crestal level (Fig.3).  The patient returns 7 months post cementation.  The access hole composite dislodges, but the abutment screw is tight, which is associated with the correct trajectory and guide.  The crestal bone contacts the implant plateau 11 months post cementation (Fig.4 arrowheads).

Return to Lower Molar Immediate Implant, Armaments 24 Xin Wei, DDS, PhD, MS 1st edition 09/04/2018, last revision 12/25/2019