Redo Implant with Existing Guide

Five months post #31 implant removal with bone graft, osteotomy is initiated for a 5x10 mm implant using an existing guide.  A question arises suddenly whether the bone height is reduced.  Therefore a 4.5x10 mm dummy implant is placed with a fixture anchor placed at #30 (Fig.1 A).  After using 4.5x8.5 mm drill with regular offset, a 5x10 mm definitive implant is placed with ~ 35 Ncm (Fig.2,3).  After placement of the implant .5 mm deeper, a 8x6 mm healing abutment is placed, while the abutments return to #29 and 30 for splinted provisional (Fig.4).  Two months later, the cemented abutment at #29 is loose (Fig.5) and retightened, but it remains incompletely seated for another 3 months (Fig.6).  So is the one at #31 (Fig.6).  After use of 4.6 and 5.6 mm bone profile drills, healing abutments are placed with apparently complete seating (Fig.7,8).

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Xin Wei, DDS, PhD, MS 1st edition 09/18/2019, last revision 02/15/2020