Lower Buccal Crest

Immediately post extraction and curettage of the large buccal apical lesion, osteotomy is established in the lingual wall of the socket of #28 (slightly distal) for 17 mm vs. 15 mm socket depth (Fig.1 (red line: Mental Loop)).  Following sequential osteotomy until 3.5x17 mm drill, a 4x10 mm dummy implant is partially placed with stability (Fig.2,3 (root measurement: mesiodistal 4 mm; buccolingual 7 mm)).  A final implant (4x11.5 mm) is placed with insertion torque of 60 Ncm (Fig.4,5).  Since the buccal crest is lower with the buccal gingival recession, the implant is intentionally placed deep as well as lingually so that autogenous bone and Vera graft mixture will be placed in the buccal gap (Fig.6 * (gauze at the moment)).  The apical lesion decreases 4.5 months postop (Fig.7).  Immediate implant and immediate provisional keep the papillae (Fig.8 *), but cannot prevent the buccal plate from atrophy (Fig.9 *).  It appears that socket shield is able to accomplish the latter.  The bone density next to the coronal threads increases 10 months post cementation (Fig.10 *) and seems to have continued to do so 1 year 4 months post cementation (Fig.11).

Return to Lower Premolar Immediate Implant, Armaments Xin Wei, DDS, PhD, MS 1st edition 02/20/2018, last revision 11/30/2019