Smooth, Precise Placement

After underdrilling (3.5x14.5 mm drill (10.5 mm offset), a 4.5x11.5 mm implant is unable to enter the osteotomy at #13; following use of 4x10 mm drill (partial normal drilling), the implant is inserted smoothly with insertion torque ~ 35 Ncm.  Sticky bone is placed in the bony portion of the buccal gap, while 2 pieces of PRF membrane in the gingival portion of the buccal gap.  The bone density at #15 is low, the insertion torque is ~15 Ncm with normal drilling without cortical tap (Fig.1).  The procedure is smooth in part due to no sinus involvement (red dashed line).  An immediate provisional FPD is fabricated for #12-14.  But local oral hygiene is difficult to maintenance.  When the wound heals at #13, the FPD is removed.  The bone loss is minimal nearly 4 months postop; the abutment at #13 is incompletely seated (Fig.2 arrowheads: gap).  After repositioning, the abutment is re-seated completely without gap (arrowheads); a 5.7x4(3) mm cemented abutment is placed at #15 (Fig.3,4).  Four crowns are cemented 4 months 10 days postop (Fig.5).

Upper Premolar Molar  Immediate Implant, Trajectory Xin Wei, DDS, PhD, MS 1st edition 06/20/2019, last revision 11/02/2019