Thick Gingiva Dictates Long Abutment Cuff

Osteotomy at #3 is initiated with 1.6 mm drill through a surgical stent.  Since the site is covered by a thick palatal flap, raising the buccal and palatal flaps turns out to be difficult.  Because of poor access, the osteotomy is expanded using Magic Expanders (ME) 3.0 and 3.8 mm for 15 mm (gingival level, Fig.1,2).  Since the gingiva is ~ 5 mm in thickness. implant system is switched from IBS (abutment with the longest cuff (4 mm)) to UF (5 mm).  The osteotomy continues with 3.8-5.0 mm UF taps (Fig.3) with ~ 20 Ncm.  The gingiva appears as thick as 7 mm.  SM implant will be used because of its 6 mm abutment cuff.

By applying 4.3 mm ME for 18 mm, a 5x12 mm SM implant is placed with insertion torque of 30 Ncm (Fig.4).  Prior to implantation, PRF plug and membrane as well as allograft (Fig.4 *) is inserted for sinus lift.  A 5.2x8(3) mm healing abutment is placed (Fig.5 H), since the uncover will be difficult with the thick gingiva.

It appears that panoramic X-ray can determine the maxillary bone height more precisely than PAs (Fig.5).  Severe postop pain is relieved when the healing abutment is removed.  The implant appears to osteointegrate 6 months postop (Fig.6) and is uncovered with placement of a 6.8x5.5(6) mm abutment.  It appears that an angled abutment is required.

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Xin Wei, DDS, PhD, MS 1st edition 04/17/2017, last revision 10/29/2017