Upper Lateral Incisor Implant Re-Placement

To have enough clearance for the splinted provisional at #6-12 (Fig.1 *), composite has been placed in the posterior teeth (bilateral, *, Fig.2).  When the composite is removed, there is no clearance between the implants/abutments of #7 or 10 (Fig.3).  Incision is made with removal of the 1-piece implant at #7; there is enough bone to move the osteotomy buccal (Fig.4 arrowhead).  When the same implant is placed buccal (Fig.5), there is sufficient clearance for restoration (Fig.6 *), while there is still enough buccal bone left (Fig.7).  When the patient returns 5.5 (for #7 and 10)/6.5 (#6,11,12) months postop, his chief complaint is tenderness lingual to #11.  In fact, the abutment screw is loose at #11, while the implant at #10 has mobility (Fig.8), which is related to loss of the posterior stops (*) due to wear.  There is slight bone loss mesial to #10 implant 5.5 months postop (Fig.10, as compared Fig.9).  CBCT taken 5.5/6.5 months postop shows no bone loss (Fig.11-15).  The 3x14 mm 1-piece implant at #10 is mobile 9 months postop and is removed and replaced by a 3.5x13 mm 2-piece one with slightly buccal osteotomy (Fig.16).  PAs are taken prior to impression (Fig.17,18).  The abutment at #12 is loose (<).  More composite needs to be added to the occlusal surface of the upper posterior teeth.  Finally the patient agrees to have crowns for the upper posterior teeth.

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Xin Wei, DDS, PhD, MS 1st edition 12/10/2018, last revision 12/13/2019