Anterior Implant Placement as Related to Nasal Floor
Immediate implant allows an anterior implant to be placed away from the nasal floor (Fig.1 arrowheads). In case the implant needs to be repositioned after osteointegration, there is room for a transverse cut (red line: vertical cut: pink). When the implant bony segment moves coronally (Fig.2 arrow), a block graft is inserted in the apical space (yellow) to prevent relapse.
In contrast, delayed implant is most likely associated with mal-positioning in 3 D, including invasion of the nasal floor (Fig.3) due to bone loss. When segemental osteotomy is needed, the transverse cut is difficult (Fig.4). The implant bone segment may be not stable once moved (Fig.5), since no block graft can be inserted, not to mention trauma and hemorrhage in the nasal floor. The segment may relapse (Fig.6).
If segmental osteotomy is the only option, the transverse cut may be through the implant (Fig.7). There will be stable fixation (Fig.8).
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Xin Wei, DDS, PhD, MS 1st edition 03/08/2015, last revision 03/08/2015