Uneven Ridge

The ridge at #31 is wide buccolingually, but uneven with buccal lower.  When a 3 mm drill reaches 13 mm in depth (Fig.1 (gingival level, flapless with Magic Split)), the patient feels pain with the osteotomy close to the Inferior Alveolar Canal (red dashed line).  Subsequent osteotomy depth gradually reduces to 11.5 and 10.0 mm before placing a 4.5x8.5 mm implant initially with high torque.  After rewinding, the implant is placed deeper (Fig.3 (implant plateau being even with the buccal crest)); a 5.5x4(2) mm healing abutment is placed due to severe supraeruption of the tooth #2.  The patient refuses orthodontic intrusion.  A prepped 5.5x4(2) mm cemented abutment is placed 6.5 months postop (Fig.3).  After reduction of the lingual cusp of the tooth #2 (barely clearance), a provisional is fabricated at #31 to intrude the opposing tooth.

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Xin Wei, DDS, PhD, MS 1st edition 12/14/2017, last revision 07/05/2018