Underprep

Due to low bone density post large implant (7 mm in diameter) removal with bone graft at #15, osteotomy with guide is underprep (last drill: 3.5x10 vs. 4.5x10 mm (design)).  When a 4.5x10 mm dummy implant is placed at the beginning of the 1st line (10.5 mm offset), the torque is ~ 15 Ncm.  As a 5x8.5 mm final implant is being placed, the torque increases to 30 Ncm (Fig.1,2) with apparently incidental sinus lift (Fig.3 arrows).  The implant remains in place with a healing abutment 2 months 9 days postop (Fig.4).  Healing abutment is changed from 5.5x6 to 6.8x5 mm 4.5 months postop when #16 MO composite is redo.  There is bone loss at #14 mesially (Fig.5 *) with microthread exposure (<) less than 7 months before loosening.

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Xin Wei, DDS, PhD, MS 1st edition 10/15/2019, last revision 01/07/2021