Limited Clearance with Opposing Tooth

In fact 5x10 mm implant placement with guide requires using 5 mm cortical tap (Fig.1).  When a 6x4 mm healing abutment is placed slightly supragingival, the clearance with the opposing supraerupted tooth is ~ 2 mm.  It suggests that orthodontic intrusion is required for restoration.  In fact the patient is incompliant with orthodontic mini-implant placement and retraction.  When the implant at #31 is osteointegrated 4.5 months postop (Fig.2), it is used an anchor with an abutment and a provisional to intrude the opposing tooth.  The final crown is cemented 10 months postop (Fig.3) with occlusal clearance (Fig.3' *).  The contacts between #2 and 3 and between #31 and 32 are loose with papillary inflammation 5 months post cementation.  It is planned to remove #31 crown/abutment for pick up impression/porcelain addition.  Instead the crown is removed.  After removing #32 MO composite with minor 2nd caries, new composite is placed (Fig.4 *) while the crown is reseated.  When the crown is recemented, bitewing shows open margin (Fig.4), but the contact is wide and tight.  After occlusal adjustment, occlusal contact at #31 and 32 mesial is heavier than that at #30.  #3 crown is recommended.  The occlusal table difference betweeen the upper 1st and 2nd molar is ~ 2 mmm preop (Fig.4'), whereas the difference is ~ .6 mm postop (in combination of occlusal equilibrium and intrusion of the upper 2nd molar (Fig.4)).  It seems that orthodontic intrusion is not efficient in a male with bruxism.  There is mild lingual (L) and distal bone loss 1.5 years post cementation (Fig.5) when CT is taken for #3 immediate implant.  Lower Molar Immediate Implant, Armaments Xin Wei, DDS, PhD, MS 1st edition 07/12/2018, last revision 11/28/2020