Establish Initial Osteotomy with Correct Trajectory

A 48-year-old man has pain 4.5 months post apicoectomy at #29 and requests extraction and immediate implant.  Since the mesiodistal bone width is limited, the 1st option is to place a narrow IBS implant (Fig.1).  First at all, use 1.6 mm drill to establish osteotomy with correct trajectory.  If the effort to change the trajectory and position fails, switch to a 3x14 or 16 1-piece implant to reduce the chance of abutment screw loosening.  If intraop PA shows the mesiodistal bone width is not so narrow and stability is not ideal, use a UF implant (Fig.2).  CBCT coronal section shows a 15 mm long implant may perforate the lingual plate (Fig.3 L).  To place an implant lingually, the coronal end of the lingual plate should be removed (*).

Return to Lower Premolar Immediate Implant, Trajectory, Metronidazole, 6th Meeting

Xin Wei, DDS, PhD, MS 1st edition 09/07/2018, last revision 09/13/2018