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Preparation for the Worst M
Five weeks post #3 immediate implant and immediate provisional, the patient complains that the implant is apparently loose. He has an implant placed in a healed site, which is successful. It is possible, because the buccal plate was lost. The insertion torque of 8x17 mm tapered implant is 40/45 Ncm. The posterior maxilla has low density bone. He is returning tomorrow.
If the implant is loose, remove it immediately. Soak antibiotic for 3 times. If there is no bone buccal to the implant site, place bone graft. Otherwise, insert 6x20 and 6.8x14 round taps to test stability. If the last tap is not stable, try to tap 7.3 and 7.5 mm cylindrical osteotomes. If they are tight, place a 7x14 or 17 mm screw implant. Due to schedule, place a healing screw.
In fact the implant is mobile. When it is removed, there is still bone buccal to the osteotomy, but the sinus membrane is perforated. After applying Clindamycin gauze for 3 times, Osteogen Plug (10x20 mm; Fig.1 *) is inserted and fixated in place with 4-0 Chromic gut suture. Then perio dressing is applied. Since the base of the alveolus is wide (Fig.1), the socket should heal with sinus membrane perforation closure in 3-4 months. A large implant should be easily placed using osteotomes. When the patient returns 3.5 months later, the buccal plate remains low. A large implant is a good option?
Xin Wei, DDS, PhD, MS 1st edition 06/17/2015, last revision 12/26/2019