Keep Abutment Tooth for Partial Denture

A 84-year-old lady (YR) has used a partial denture for #11-13 for 5 years (Fig.1).  The abutment tooth #10 has fractured recently (Fig.3).  An immediate implant and provisional will let her use the partial soon.  Considering her age, a long implant should be placed with underprep (socket soaked with no antibiotic).  A 2 mm pilot drill will be used for <20 mm; 2.5 mm reamer for 14-17 mm and 3 for 11-14 mm.  Look out for the trajectory while drilling.  Use the tooth #9 and the partial denture as positioning guides (Fig.4).  A 4x20 mm implant will be placed; attention is being paid to the trajectory while in placement (Fig.2). 

In fact, a 4.5x20 mm implant is placed because of D3,4 bone (Fig.4, insertion torque >60 Ncm). Three months postop, grafted bone has adapted to the implant surface (Fig.5 <).  After reprep and impression, shade A3 is selected (Fig.6).  There is no bone resorption 7 months post cementation (Fig.7).  The patient experiences pain after eating chicken leg 2 years 2 months post cementation; it appears that the tooth #9 has apical infection (Fig.8,9 *).

If the tooth #9 needs extraction and implant, osteotomy should be underprep.  The implant could be smaller (3.8 mm) and shorter (15 mm bone level).  CT taken 2 years 9 months post cementation show that the implant (4.5x20 mm (tissue-level)) is large for the bone (Fig.10), as compared to the one placed at #7 (2.5x14 mm (bone-level)).

Return to Upper Incisor Immediate Implant, Technicians 7

Xin Wei, DDS, PhD, MS 1st edition 10/04/2015, last revision 10/18/2018