Change Trajectory

After sectioning the splinted crowns at #8 and 9 (Fig.1,2 (*: open bite)), the tooth #9 is deemed nonsalvageable because of caries and the crown/retainer of #8 is recemented.  The trajectory of initial osteotomy is off (Fig.3 (red line: ideal trajectory)).  Using Lindamann bur twice does not improve the trajectory (Fig.4,5).  It appears that a new osteotomy should be established in the distal wall of the socket (Fig.5 red line (initial entry point and angle), Fig.6).  Following sequential osteotomy, a 4x10 mm dummy implant is placed with stability and ~ 3.5 mm apical space (Fig.7 red line).  A final implant (4x11.5 mm) is placed subcrestal (except buccal, Fig.8).  With further placement of the implant, a 4.5x5.5(3) mm abutment and Vera graft are placed (Fig.9) prior to fabrication of an immediate provisional.  In all, a new osteotomy site should be set up when the trajectory is to be changed substantially.  There is no gross bone loss 4.5 months postop (Fig.10).  There is shade mismatch when a porcelain-fused-Zirconia crown is tried in (Fig.11, as compared to Fig.1).  The latter is corrected when a PFM crown is cemented (Fig.12).

Return to Upper Incisor Immediate Implant, Armaments Xin Wei, DDS, PhD, MS 1st edition 02/13/2018, last revision 08/13/2018