Osteotomy in Septum by Reamers for Immediate Implant

After atraumatic extraction, osteotomy is initiated in the septum 11 mm deep (Fig.1).  Since bone density is high, reamers are used to enlarge the osteotomy, followed by insertion of taps until 6x17 mm (Fig.2 T).  When the latter is removed, the osteotomy (Fig.3 O) is surrounded by the bone.  The primary stability of a 6x17 mm implant is high (>60 Ncm, Fig.4 I).  An abutment (A: 5x3 mm) is immediately placed for an immediate provisional; autogenous bone graft mixed with Osteogen is placed in the remaining gap (*).  After the socket heals, the provisional is dislodged.  No attempt is to fabricate a new one.  The patient returns for final restoration impression 3 months postop.  It appears that the mesial gap has been decreased (Fig.5 ^).  CT taken 7 months postop, 3 months post cementation shows that the implant is placed in the middle of the alveolus (Fig.6 (B: buccal)).  There is no bone loss 1 year 7 months post cementation (Fig.7).

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Xin Wei, DDS, PhD, MS 1st edition 06/19/2015, last revision 12/31/2017