Immediate Implant Replacement with Periimplantitis

A 56-year-old woman has sign of periimplantitis 2 years 9 months post cementation.  After incision, the 5.5x13 mm bone-level implant is ~ 3 mm inferior to the buccal crest.  The implant is removed with 7/6 mm trephine bur, elevator and implant driver.  The sinus membrane perforates.  A 8x17 mm tap achieves stability (Fig.1), but the peripheral bone seems to be thin.  Although a 7x14 mm tissue-level implant has stability, it is placed too deep (Fig.2).  Following insertion of a piece of Osteogen plug for sinus membrane repair, a 8x14 mm implant is placed with >40 Ncm with allograft placed around the unpolished portion of the implant (Fig.3,4).  A 6x3 mm abutment is placed to hold periodontal dressing in place.  Because of the abutment with a slot (Fig.5 A), the periodontal dressing remains in place 4 days postop before the patient travels back home for 4 hours.  In fact there is no postop sinus infection; the implant threads seems not be exposed 3 months postop (Fig.6).    Because of the large implant, it is loaded early (Fig.7, 8 (Temp Bond)).  Upper Molar Immediate Implant, Trajectory II 劈开术 Xin Wei, DDS, PhD, MS 1st edition 08/09/2019, last revision 04/11/2021