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5x10
mm Immediate Implant
While the tooth #3 has a mesiodistal crack line, etiology may be due to chronic periodontitis with bruxism. After extraction, there is granulation tissue attached to the distobuccal (DB) root. The DB socket is larger than the mesiobuccal one (Fig.1). Osteotomy is initiated in the DB slope of the septum for 10 mm (Fig.2,3). Since there is ample apical bone, the depth of the osteotomy increases to 11.5 mm. When a 5x10 mm dummy implant is placed, primary stability is satisfactory (Fig.4 (yellow line: apical space)). The definitive implant remains the same dimension with deeper placement (Fig.5,6 (~ 20 Ncm)); with placement of a 6.5x4(3) mm abutment and Vanilla/Osteogen Graft (*), an immediate provisional is fabricated in place (without taking out for trimming) with sufficient clearance with the opposing dentition. It appears that the moderately long implant (10 mm) is able to achieve primary stability for immediate placement. When the provisional is removed 2 months postop, bone graft seems to be adhered to the socket (Fig.7). To improve local hygiene, the provisional does not return. The implant seems to have osteointegrated 3.5 months postop (Fig.8). The crown/abutment is loose approximately 1 year post cementation. Due to her daughter's contracting COVID 19, she postpones returning for approximately 1 year. The access hole is opened, crown/abutment (6.5x4(4) mm) removed, proximal contacts reduced, crown/abutment reseated without certainty. BW shows incomplete seating probably due to bony interference (Fig.9). A 5.5x4(4) mm can not be seated (bouncing, probably due to soft tissue interference). When a 4.5x5(4) mm abutment (UF) is seated, hand tightening is smooth, confirmed by BW (Fig.10). Two weeks later, the new crown is cemented intraorally. The crown/abutment is removed for cleaning. The abutment screw is torqued at 20 NCM.
Return to Upper Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table), Armaments
Xin Wei, DDS, PhD, MS 1st edition 07/22/2018, last revision 07/22/2018