Dense Bone Appears to be Peripheral and Deep

With one carpule of 2% Xylocaine with 1:100,000 Epinephrine, there is no intraop pain associated with placement of 2 implants with guide (Fig.1).  Postop pain is minimal.  Difficulty is high torque in insertion.  At the site of #15, there is no bone shaving associated with 4 mm or less drills.  The deeper portion of the bone seems to have denser bone.  In spite of using 5 mm tap, which is not recommended, the insertion torque is so high that the implant has to be backed up several times before placement with ~ 50 Ncm.  Bone profile is used at #14 before placement of a 5.5x7 mm healing abutment.  The healing abutment at #15 dislodges 3 weeks postop and changes to a 5.5x5 mm one.  No bone loss is observed 4 months postop (Fig.2).  After failure to deliver crowns using impression coping, abutments are placed. The one at #15 is incompletely seated (Fig.3 <) probably due to the contact with the distal crest (*).  Change to a smaller one results in complete seating (Fig.4).  Cementation of the crowns with access holes is related to no residual cement (Fig.5).

Return to Upper Molar Immediate Implant Trajectory 2 3 31Xin Wei, DDS, PhD, MS 1st edition 04/23/2019, last revision 07/12/2020