Not So Palatal

Since the implant is placed buccally at the site of #30, effort is exerted to place the one at #14 (Fig.1) as palatal as possible.  After residual root removal, there is a tissue tag between the mesial and distal sockets (Fig.2).  The tag (Fig.2' *) is incised palatally (black line) and reflected buccally (Fig.3 *) to reveal the 3 sockets.  Osteotomy is initiated in the center of the sockets, i.e., the convergent point of the 3 thin septi (Fig.3' black circle).  Since the bone is dense and the septal top is pointed, the osteotomy has to be enlarged with Magic Drills sequentially (until 5.3 mm in diameter, 7 mm in depth).  In fact the osteotomy is found to be slightly buccal.  There is no sinus membrane perforation before sinus lift with allograft and Magic Expander 4.8 mm.  The perforation is repaired by insertion of collagen plug.  A 6x9 mm IBS implant is placed with >55 Ncm, barely penetrating the sinus floor (Fig.4 ^).  The implant is turned 2 more times; more allograft is placed in the remaining sockets (Fig.5 *) before and after placement of a 6.5x4(3) mm abutment (A).  The buccal gap is ~ 1 mm vs. 2-3 mm palatal when the implant is placed.  In retrospectively, the initial osteotomy should have been more palatal than the black circle in Fig.3'.  The palatal socket is larger than the distobuccal one buccopalatally (Fig.3).

There is no nasal hemorrhage postop.  Magic Sinus Lifter and PRF may be helpful when bone height is limited.  The patient returns for impression 10.5 months postop (Fig.6).  Dense bone forms around the coronal end of the implant 1 year post cementation (approximately 2 years postop, Fig.7).  Success is due to long healing time (10.5 months).  IBS implants take time to heal.

Return to Upper Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table)

Xin Wei, DDS, PhD, MS 1st edition 11/18/2016, last revision 11/04/2018