Largest Implant for Upper 2nd Molar

When the residual roots are removed, the socket is large, single and 11 mm deep.  Tapered osteotomes (2, 3, 4 mm) are used to gain 3 mm new bone apically and lift the sinus floor.  The osteotomy is further increased by using tapered taps (from 4.5 to 7 mm with increasing stability).  Fig.1 shows a 5 mm tap in place, while Fig.2 the socket and the osteotomy (arrowheads) after osteotome and tap application.  A 8x14 mm implant is placed with insertion torque >60 Ncm (Fig.3,4 I), followed by 6x3 mm abutment (A).  The implant threads appear to have been embedded into the wall of the osteotomy (Fig.4 <).  Although the 5 mm tap and 8 mm implant appear to protrude into the sinus cavity, there is no air leakage.  The implant appears to be supported by the native bone in the sinus (Fig.5 *), in the same manner that the palatal (Fig.5') root is surrounded by the bone. 

An immediate provisional dislodges twice postop.  Less than 2 months postop (Fig.6), the gingiva is healthy around the implant/abutment.  Impression is taken for final restoration.

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Xin Wei, DDS, PhD, MS 1st edition 09/21/2015, last revision 11/17/2015