Screw Implant with Low Stability

When the mobile tooth #18 with apical granulation tissue is extracted, the socket is large and long (close to the Inferior Alveolar Canal (Fig.2,3 red dashed line).  Without drilling, a 7 mm bone level tap does not obtain stability.  A 8x17 mm tapered tap reaches the bottom of the socket with minimal stability, but coronally it is close to the tooth #32 (Fig.1).  When a 7x14 mm cylindrical tap is placed, it is shy of the bottom of the socket (Fig.2 *), but the trajectory improves.  A 7x14 mm tissue-level implant is placed with ~45 Ncm (still not secure) with Vanilla graft placed mainly distolingually (Fig.3).  With the large implant, the socket is closed 8 days postop (Fig.4).  The soft and hard tissues appear to heal 3 months postop (Fig.5,6).  A healing abutment (Fig.7 H) is placed to push the mesial papilla mesially (*).  Two weeks later impression is taken with ease because of the healing abutment.  There is no bone loss 4.5 months postop (immediately post cementation, Fig.8).

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Xin Wei, DDS, PhD, MS 1st edition 04/30/2018, last revision 09/12/2018