Following insertion of 4 mm tap drill with low stability, a 4.5x16 mm implant is placed with >45 Ncm (Fig.4).  After placement of a 4.5x7(4) mm abutment and of a piece of PRF membrane against the buccal wall of the socket, Vanilla allograft is packed buccodistally (Fig.5 black *).  Post incision, the ridge at #6 and 7 is found to be narrow for implant placement; after bone graft (white *) and PRF membranes buccopalatally, the wound is closed.  If the mesial crest does not resorb, the abutment cuff should be changed to 5 mm or a mill abutment (4.5x2 mm) is to be used.  Some of the bone graft remains distal to the coronal portion of the implant 5 months postop (Fig.13).  A fistula forms 11 months postop (Fig.13) and is associated with implant thread exposure (Fig. 14, as compared to Fig.2).

Larger Implant for Primary Stability Block Graft Last Next

Xin Wei, DDS, PhD, MS 1st edition 08/24/2017, last revision 07/20/2018