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