When a definitive implant (Fig.4: 4.5x11.5 mm( *: bone graft)) is placed with primary stability, there is an apical space (Fig.5 white double arrows).  There is moderate postop pain.  A shorter implant (10 mm) should be tried when the bone is dense.  It will be associated with less pain.   The fistula disappears 7 days postop (Fig.6).  Although the patient appreciates that the pain is gone, there is atrophy mesiobuccally 2 months postop (Fig.7 *).  The implant seems to be have been placed too buccally (Fig.8).  With loss of the buccal plate, the implant should be placed away from it to prevent periimplantitis.  The abutment is changed from 6.5x4(4) to 6.5x5.5 (3) mm with fabrication of a new provisional.  The buccal margin is still supragingival 6 months postop and prep lower before impression (to reduce food impaction).  The mesial and distal sockets appear to have healed (Fig.9).  The bone density around the implant increases 11 months post cementation (Fig.12).

Shorter Implant Less Pain Last Next Xin Wei, DDS, PhD, MS 1st edition 04/20/2019, last revision 04/20/2019