Immediate Redo

Eleven months post immediate implantation, the implant at #8 (4.5x16 mm, better smaller) is found to have thread exposure buccally (Fig.1) and distally (Fig.2).  Immediately post implant removal, a 5x10 mm one is placed equi- or subcrestally distobuccally (Fig.3,4 (to prevent periimplantitis)).  It is turned 4 more times later to make sure slightly supracrestally palatally, since the palatal crest is the lowest.  After placement of sticky bone palatally, a 4.5(2) mm mill abutment is placed (17 mm long, Fig.5,6).  The buccal flap is raised until the anterior nasal (Fig.5 N) foramen.  After severing the periosteum and placement of 2 of 8 mm tenting screws (Fig.7), sticky bone (Vanilla allograft/Osteogen; block graft denies) is applied at #6 and 7 sites (Fig.8).  Following palatal flap separation, the wound is closed in an apparent tension free manner (Fig.9).  Periodontal dressing is applied.  After wound healing, lab-fabricated provisional is delivered.

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Xin Wei, DDS, PhD, MS 1st edition 07/26/2018, last revision 12/23/2018