Mill Abutments Replace Abutment with Long Cuff

After extraction, the depths of initial osteotomy at #2, 3 and 5 are 13, 11.5 and 10 mm, respectively (Fig.1).  Following adjustment of trajectory, a 3.8x13 mm UF implant is placed at #5 (Fig.2) with insertion of a 4.5x2 mm mill abutment as well as mineralized cortical/cancellous allograft (Vanilla, *).  The mill abutment is chosen because the margin of a 5.5x7(5) mm cemented abutment is severely subgingival (Fig.4 at #3; ^ gingival margin).  By the same token, a 4.5x3 mm mill abutment is placed at #2.  In fact all of the 3 implants are placed 2-3 mm out of the bone (Fig.5).  To prevent periimplantitis, abundant allograft is placed around the implants/abutments (Fig.2,4 *).  Nearly 2 months postop, the mill abutment at #2 is adjusted for its height, while a 5.5x2.5 mm mill abutment is placed at #3 (Fig.6).  To regain the buccal gingiva, the buccal margin of the provisional is shortened (Fig.6,7).  Two weeks later, the gingival regrowth is not obvious (Fig.8 (nearly 3 months postop)).  Local poor oral hygiene remains.  A provisional FPD is fabricated.  If his occlusion is normal for another 2 weeks, impression will be taken for upper (or UL) permanent restoration.

Return to Full Mouth, Upper Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table), IBS, 9-11, #15

Xin Wei, DDS, PhD, MS 1st edition 08/11/2017, last revision 11/04/2017