Sequence of Osteotomy for Immediate Implant for Upper 2nd Molar

A 36-year-old lady presented to clinic with DO 2nd caries of the tooth #2 10 years ago (Fig.1,2 *).  When she returned recently, the tooth fractured nonsalvageably (Fig.3,4).  It appears that the buccal roots fuse, suggesting that the buccal socket is larger than the palatal one.  An immediate implant will be placed in the buccal slope of the septum.  The initial entry point should be slightly palatal, expecting that the osteotomy will shift buccally while it is being enlarged with drills or osteotomes in the slope.

It appears that the septum is ~ 6 mm in height (Fig.5).   Take a PA after extraction for exact measurement of the bone height.  A 2 mm pilot drill will be used to start osteotomy for 6 mm.  If the bone feels soft while drilling, osteotomes will be used for further osteotomy.  Otherwise, reamers will be used until 3.5 mm.  Then taps starting 4.5x14 mm until 7x14 mm will be inserted.  The depth will be sequentially increased while the diameter of the taps increases until 14 mm against the gingival margin.  The goal is to place a 7x14 mm tissue-level implant.  If the last tap (7x14 mm) is tight, a 7x12 mm bone-level implant may be tried.

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Xin Wei, DDS, PhD, MS 1st edition 04/26/2015, last revision 10/21/2019