Osteotomy Deviation

Buccal swelling is severe at #30 before extraction (Fig.1 *).  Retrieval of fractured roots is extremely difficult due to hard bone.  Hemorrhage seems to be inconsistent with osteonecrosis.  The bone is so hard that the 2 mm drill does not reach the predetermined depth (15 mm vs. 13 mm (Fig.2)).  What is ignored is the mesial deviation of the initial osteotomy (Fig.2 <).  The osteotomy shifts to the mesial socket with the next drill.  The severity of the deviation is not found until a 5x11.5 mm implant is placed (Fig.3).  While Osteogen plug is placed in the apical socket (P), Vanilla (allograft) mixed with Osteogen in the coronal socket (*).  Because of tight schedule and partial flap (to remove fractured roots), periodontal dressing is applied around the immediately placed abutment (for retention).  The socket heals except mesially 3 weeks postop (Fig.4).   In spite of good oral hygiene, the mesiobuccal papilla defect remains 5 weeks postop.  A provisional (Fig.5 P) is fabricated for easy self cleansing.  The implant seems to have osteointegrated 3.5 months postop (Fig.6, a month post abutment dislodgement).  Screw loosens 4 months postop with buccal access hole and wide buccolingual width.

Return to Lower Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table), Armaments Xin Wei, DDS, PhD, MS 1st edition 05/31/2018, last revision 03/06/2019