3 Implants with Triple Difficulty I

Extraction of abutment teeth associated with the loose FPD is not as easy as expected.  Bony anchor placed at #14 (Fig.1 B) becomes loose while initial osteotomy a 2.2 mm drill at #13 for trajectory confirmation.  The sinus membrane perforates at #15 when the sinus probe is being used.  Luckily the perforation appears to be repaired with 2 pieces of PRF; sinus lift is assisted with a 4.5x10 mm dummy implant (Fig.2 *).  Sinus lift at #14 is difficult and incomplete because of small osteotomy (Fig.3,5).  In fact there is no sinus infection postop.  Splinted immediate provisional is fabricated, but should be sectioned for individual units to form gingival scallops with distinct papillae to reduce food impaction.  This patient could not maintain oral hygiene as well as the previous one.  Three months postop, the splinted provisional is removed.  The abutment at #14 is supragingival and is changed to 4.5x7(3) mm one.  Individual temporary crowns are fabricated.  Two weeks later, a small papilla forms between #14 and 15, while the temp at #13 is lost.  The abutment at #13 changes to 4.5x7(5) mm one (Fig.7) with a new provisional, whereas those at #14 and 15 relined.  In fact the abutment at #15 is incompletely seated (<) probably related to contact with the mesial crest (*).  An abutment with smaller diameter and longer cuff at #15 seems to be completely seated (Fig.8,9, as compared to Fig.7).  Following screw torque at 30 Ncm, impression is taken.

Return to Upper Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table) Trajectory II
Xin Wei, DDS, PhD, MS 1st edition 10/25/2019, last revision 04/12/2020