Low Torque
In spite of underprep (4.0x8.5 mm last drill), a 5x8.5 mm implant is placed at #2 with insertion torque ~ 15 Ncm (Fig.1). In addition to the large defect post implant removal with 4.5 month bone graft, he is a heavy gagger with limited mouth opening. Drill cylinders may not engage the metal sleeve precisely. A 5.5x4 mm healing abutment is placed with low emergency profile. The procedure, although difficult, finishes in a timely manner. Otherwise it would be a disaster for the patient and operator. PA taken 1 month postop shows slightly subcrestal placement (Fig.2). When a cemented abutment is placed 4 months postop, there is tenderness. In fact the implant is mobile. A 8x5 mm healing abutment is placed. Nine months postop, the implant remains slightly mobile (Fig.3); a healing screw is placed. The tooth #3 has sign and symptom of crack 13 months postop (Fig.4), related to root fracture of #19 (Fig.5, bruxism). In fact the tooth cracks nonsalvageable post RCT, 9 months post #2 healing screw, 21 months postop. Socket preservation will be carried out with sticky bone and PRF, while #2 implant will be uncovered, followed by placement of a short cemented abutment to hold periodontal dressing. Upper Molar Immediate Implant, Trajectory Xin Wei, DDS, PhD, MS 1st edition 11/27/2018, last revision 07/03/2021