Short, Hard Bone

Bone height at #14 two months post exfoliation is ~ 4 mm (Fig.1).  Bone expansion is difficult because of dense bone.  After drilling, a 4.5 mm tap is inserted with stability (Fig.2).  Sinus lift is accomplished with RT3 and autogenous bone prior to placement of a 4.5x8.5 mm implant (Fig.3).  Because of flapless surgery and tight and long gingiva, bone graft around the coronal end of the implant is intentionally not placed.  A 5.5x5(4) mm abutment is immediately placed for an immediate provisional.   (Fig.4).  Take PA and impression when the patient returns.  The provisional dislodges 3.5 months postop (Fig.4); impression is taken.  The patient reports hot sensitivity and pain after meal at the implant site (Fig.5).  After removal of the implant crown/abutment, she feels better.  If not, it seems necessary to extract the tooth #13 for a 13 mm long implant with a mill abutment (Fig.6).

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Xin Wei, DDS, PhD, MS 1st edition 12/28/2017, last revision 03/10/2019