Implant in Low Density Bone

A 46-year-old lady used to have a 3-unit bridge from #2 to 4 (Fig.1).  Because of caries, the tooth #2 has root canal therapy.  Now it is asymptomatic.  The bone density at #3 is low, as compared to the area between #4 and 5 roots (Fig.1).  Besides, the ridge at #3 seems to be pointed (Fig.2 *). After incision, use Bicon 2 mm pilot drill to initiate bone expansion (6-8 mm).  Insert a calibrated parallel pin for PA to confirm the depth relative to the sinus floor.  The last expander should be 2-3 sizes smaller than the final one of the implant.  Take 2nd intraop PA with the last expander to determine the depth of osteotomy (whether sinus lift is necessary).  A gingiva-level (Fig.3) or UF implant will be placed.  Fabricate splinted immediate provisional between #2 and 3.

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Xin Wei, DDS, PhD, MS 1st edition 11/21/2015, last revision 12/11/2015