Preop exam confirms that the tooth #13 is non-salvageable. After extraction, a 2 mm pilot drill is used to start osteotomy in the mid palatal wall more than 13 mm (Fig.1). Bone density is low (smoker). The longest (at that time, now 15,16,18 mm available) bone-level implant (4.5x13 mm, Fig.2) is placed with insertion torque of 35 Ncm after using 3.2 mm drill (1 drill underprep).
With a small piece of gauze in the implant well (Fig.3 G), bone graft is placed in the remaining sockets (*). When the gauze is removed, a 5.5x4(3) abutment is placed. The mesial surface of the tooth #14 (Fig.2 <) is reduced before fabrication of an immediate provisional. Collagen dressing is placed over the bone graft before provisional cementation.
When initial drilling indicates soft bone, an immediate implant should be as long as possible to achieve primary stability. This is especially true for the the anterior teeth (including premolars) where the buccal wall of the osteotomy is short. Or osteotomy should be 2 drill underprep.
The patient returns for restoration 4.5 months postop, the 5.5x4(3) mm abutment seems to be wide (Fig.5 A). It is changed to a 4.5x4(3) mm one before impression.
Since the implant is placed palatally, the buccal margin of the permanent crown should be similar to that of the neighboring teeth (for cosmetics; not too short or too long), while the palatal margin should be supragingival if possible (for hygiene).
Return to Upper Premolar Immediate Implant,
Xin Wei, DDS, PhD, MS 1st edition 09/29/2015, last revision 03/13/2016