Immediate Provisional Bridge for Smoker

A 49-year-old man cannot quit smoking.  The lower left fixed partial prosthesis (FPD) has been dislodged (Fig.1).  It appears that the patient is a bruxer.  The bone height seems to be unlimited (yellow line in Fig.1,2: the upper border of the Inferior Alveolar Canal).  It should be safe to place a 12 or 14 mm long bone level implant (Fig.2).  The initial osteotomy depth is 12 mm.

The bone width (buccolingual) is apparently good clinically.  Take photos to show the latter prior to local anesthesia.  After raising flaps, use a 5 or 6 mm implant positioner to determine the proper diameter of the implant.  Use the DIO kit.  If the bone is soft, underprepare the osteotomy.  Save bone as much as possible.  Try to use 50 RPM instead of 800 to see whether the burs can function as reamers.  Use the latch driver to place the implant.  If the machine stalls by itself at 55 Ncm, use DIO own wrench to finish placement.  When the insertion torque is high, fabricate an immediate provisional FPD.

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Xin Wei, DDS, PhD, MS 1st edition 07/06/2015, last revision 07/13/2015