1-Piece Implant Placement Without Trajectory PA

The mesial surface of the tooth #31 is reduced prior to osteotomy (Fig.1 >) so that the mesiodistal width of the edentulous area is 4.5 mm.  An incision is made instead of tissue punch because of the narrow keratinized gingiva.  The potential osteotomy site happens to have nonkeratinized tissue.  When a 2.5x12(2) mm 1-piece implant is placed, it is close to the curved root of the 2nd premolar (Fig.2 *).  Because of apparently sufficient clearance from the Inferior Alveolar Canal (Fig.2 red dashed line), the implant is placed ~ 1 mm deeper later.  After suturing, periodontal dressing is applied.  At patient's request, a provisional is fabricated with occlusal clearance 26 days postop.  The occlusal surface of the provisional perforates 3.5 months postop with the provisional having pressed the gingiva, which is consistent with crestal bone loss (Fig.3).  There appears no bone loss 3 months post cementation (Fig.4).  There is minimal bone loss 11 months post cementation; in fact the bone density around the coronal portion of the implant increases (Fig.5).

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Xin Wei, DDS, PhD, MS 1st edition 06/01/2018, last revision 09/18/2019