Deep Placement with Thread Exposure

A few days prior to surgery, the tooth #12 developed abscess, self controlled by water pik (Fig.1 *).  The buccal plate is defective.  Initial osteotomy is close to the root of the tooth #11 (Fig.2).  After adjustment of the trajectory and the depth of osteotomy (Fig.3), a 3.8x15 mm dummy implant is placed (Fig.4,5).  In spite of a shorter implant (3.8x13 mm) placed deeper, approximately 7 mm implant threads are not covered buccally by the native bone (Fig.6 red dashed line).  If the implant were placed deeper, the crown/implant ratio would become more unfavorable (abutment screw loosening, Fig.7).  Since a mill abutment (4.5(2) mm) is inserted before Vanilla Graft, the deepest portion of the socket is unfilled (Fig.7 *).  With meticulous use of a long explorer and additional allograft, the space is closed (Fig.8 *).  The buccal plate collapses with apparently fistula formation 2 months postop.  The patient removes the provisional for cleaning.  It appears that the mill abutment is buccally placed and needs heavy reduction.  The mill abutment is loose 2 months 10 days postop.  When it is retightened, it tilts distal.  Bone remains around the implant 6 months postop (Fig.9).  Without a provisional at #12 for 5 months, the tooth #13 appears to have been shifted mesially (Fig.10 arrow).  The mill abutment at #12 changes to a healing one.  A lingual button is placed in the mesial surface of #13.  Splinted provisional is fabricated with supraocclusion at #14 and 15 as an anchor (implants).  The tooth #13 is being distalized with power chains.  Limited ortho is finished nearly 2 months post banding (Fig.15,16).

Return to Upper Premolar Immediate Implant, Armaments #3 10 14/15 18 30 Xin Wei, DDS, PhD, MS 1st edition 06/15/2018, last revision 03/08/2019