Tissue Punch: No Postop Pain

The patient is extremely nervous about implant placement at #14.  Access is obtained with a 4 mm tissue punch, which appears to be the least traumatic.  Since the gingiva is ~ 5 mm thick, vision is poor and it is difficult to change osteotomy buccally.  It seems a 6 mm tissue punch is more appropriate for this case.  The initial osteotomy depth is 14 mm (Fig.1).  Since the tooth #15 is nonsalvageable because of furca caries and bone loss (Fig.1 *), the distal osteotomy at #14 is apparently acceptable.  When a 5x13 mm implant is placed with >50 Ncm (Fig.2), the implant is subcrestal clinically except palatal (osteotomy not buccal enough), which is consistent with bitewing view (Fig.3).  A 5.5x5 mm healing abutment is placed.  Surprisingly the fearful patient does not experience any pain.  Tissue punch is an atraumtic measure.  A larger one (6 mm) allows more room to change osteotomy.  The access can be closed with larger healing abutment.  If this implant fails due to periimplantitis, it is due to palatal placement with too large the implant (5 mm vs. 4 mm at #3).  Palpate the bone prior to changing next large drill when performing a flapless procedure.  The implant seems to be osteointegrated 5 months postop; the furca caries (Fig.4 *) is taken care of before impression with a 4.5x5(4) mm abutment.  Distal caries of the tooth #13 is found 10 months post cementation (Fig.5).  Strict oral hygiene for prevention should have been given after composite for the furca of the tooth #15 (*).

Return to Upper Molar Immediate Implant, Armaments Xin Wei, DDS, PhD, MS 1st edition 04/19/2018, last revision 08/11/2019