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