Thin Buccal Plate

When the tooth #6 with loose crown and post (Fig.1) is extracted, there is no granulation tissue in the socket with the thin intact buccal plate.  As planned, osteotomy is initiated in the mesio-palatal slope of the socket (Fig.2 red dashed line).  After osteotomy for 3x20 mm (gingival level), a 3.8x15 mm dummy implant is placed partially (Fig.3 D).  A final implant with the same dimension is placed with > 50 Ncm (Fig.4).  Before and after placement of a 4.5x5(3) mm abutment, Vera graft is placed in the remaining socket space (mainly buccal, Fig.5 *).  As routine, an immediate provisional is fabricated with occlusal clearance.  The gingiva looks healthy around the provisional 1 week postop (Fig.6 P).  Adjust and polish the mesioocclusal composite at #5 if necessary before impression.  The bone graft appears to remain in place 4.5 months postop (Fig.7).  A bevel buccal subgingival margin is placed prior to impression.  The bone density around the coronal portion of the implant increases 9 months postop (4 months post cementation, Fig.8).  There is no gingival erythema or edema around the implant crown at #6 ten months post cementation (Fig.6, as compared to preop condition and that of the neighboring crown (*)).  Both the buccal and palatal plates are thin or absent 1 year 5 months post cementation (Fig.10).  Socket shield should be done with a smaller implant.

Return to Upper Canine Immediate Implant, Armaments 18 Xin Wei, DDS, PhD, MS 1st edition 01/26/2018, last revision 11/22/2019