Difficulty in Placing Non-Immediate Implant M

Placement of the non-immediate implant at the site of #14 turns out to be extremely difficult from the very beginning partially due to the distally curved root of the 2nd premolar (Fig.1: parallel pin).  With effort, the trajectory is corrected to certain degree, but not the position (Fig.2).  When a 4.5x11 mm tap is inserted (Fig.3,4), it appears that the osteotomy cannot afford to increase in diameter too much, although there is enough bone buccopalatally.  A 5x11 mm implant is placed with insertion torque > 60 Ncm (Fig.5).  Autogenous bone and Osteogen is placed distolingually.  A provisional is cemented 2 weeks postop.  The implant appears to be osteointegrated 3.5 months postop (Fig.6).  A permanent crown is cemented 5 months postop.  There is no bone loss 1 year 7 months post cementation (Fig.7). With non-immediate implant at the first molar, the trajectory may be inadvertently not ideal, but the position may not be corrected to large degree.  With taking early intraop PA with a parallel pin, trajectory issue is avoidable.  The immediate implant (6x14 mm) is always larger and longer than non-immediate one (5x11 mm) for the same patient.  Return to Upper Molar Immediate Implant 19 Xin Wei, DDS, PhD, MS 1st edition 05/04/2015, last revision 12/26/2019