As Simple As Possible

A 46-year-old lady is a dental phobic.  She has had extraction ortho.  The tooth #14 must have been nonfunctional for quite a while, as evidenced by distal shifting of the 2nd premolar (Fig.1 open arrow).  The mesiodistal edentulous space is narrow.  The diameter of the immediate implant should not be more than 6 mm (Fig.2).  The bone height is somewhat limited, since the sinus floor (Fig.1 ^) is inferior to the palatal apex (P).  After extraction, initial osteotomy depth is 11 mm from the gingival margin (~ 1 mm from the sinus floor).  As the diameter of osteotomy increases, the depth can be eepened to 14 mm.  Therefore the implant can be 6x14 mm (Fig.2); the height is between the sinus floor and the palatal apex.  To prevent further tooth shifting during osteointegration, an immediate provisional will be fabricated (Fig.3 red).  When osteointegration occurs, place a rubber separator between the provisional and the 2nd premolar (blue) so that the latter will gradually move (open arrow) back to its original place.  A definitive restoration will be made.

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Xin Wei, DDS, PhD, MS 1st edition 01/02/2015, last revision 01/03/2015