There are 2 abscesses immediately prior to extraction of the tooth #2 (Fig.1,2: B (buccal), L (lingual)). It is basically 1 walled defect, severe bone loss of the buccal, lingual (palatal), mesial and socket floor. The sinus floor defect is ~ 4 mm in diameter, but the sinus membrane is intact. Tapered taps are used to form osteotomy; the largest one (Fig.3 T: 8x17 mm) barely achieve stability. The largest cylindrical tap (6.8x14 mm) has no stability. Fortunately a 8x17 mm tissue-level implant has insertion torque of 50 Ncm (Fig.4). A 6x5 mm abutment is placed for an immediate provisional. Two piece of Osteotape is applied to repair the buccal and lingual walls, followed by allograft and Osteogen. The opening of the socket is sealed with Collagen dressing.
The cylindrical implant has larger surface area and higher insertion torque than the tapered implant with the same diameter.
PA taken immediately post cementation shows that bone contacts implant threads (Fig.5 (3 months 3 weeks postop)).
CBCT taken 12 months post cementation (16 months postop) shows implant threads being covered by the bone (Fig.6 (sagittal section; D: distal), 7 (coronal section; buccal on the left of the figure)). When the lower left FPD is failing, the patient complains that she cannot masticate well on the right side (Fig.8). It appears that there is no occlusal contact involving implant crowns at #2 or 31 (Fig.9 *).
Return to Upper Molar Immediate Implant,
CT Follow up,
Xin Wei, DDS, PhD, MS 1st edition 09/25/2015, last revision 11/01/2018