Osteotomy for immediate implant is initiated in the center of the septum with the coronal end of drills and implant (Fig.4 I (5x12 mm)/abutment (Fig.4,5 A (7.8x5.5(2) mm) in the center of the edentulous space as much as possible.  Prior to implant placement, mixture of allograft and Osteogen is used for sinus lift (Fig.4 *).  After implant placement, Osteogen plug is inserted into the 3 sockets (mesiobuccal, distobuccal and palatal) until the plateau of the implant, while Collagen plug is placed in the socket between the implant plateau and the abutment margin.  It is hoped that the former facilitates bone regeneration, while the latter gingival regrowth (to correct gingival recession).  No bone graft appears to be placed in the sockets.

In fact, the patient returns 4 months postop.  The provisional perforates at the occlusal surface, but there appears to be new bone formation in the mesial socket (Fig.10 *).  Remember no bone graft being placed in the mesial socket (instead Osteogen plug being used).  Bone density immediately next to the implant (including sinus lift) increases nearly 7 months post cementation (Fig.14).  The tooth #2 develops mild periodic pain without deep pockets 13 months (Fig.18) and 2.5 years (Fig.19) post cementation of the crown at #3 with dense bone formation (*) next to the implant.

Graft Materials Last Next Xin Wei, DDS, PhD, MS 1st edition 12/28/2018, last revision 01/04/2020