Implant 2nd Placement with More Bone Graft

Five months post implant failure and socket preservation, the mesial crest at #19 is low (Fig.1 *).  After 1.6 mm drill, Magic Expanders are used to finish osteotomy, followed by insertion of a 5x11 mm dummy implant with low stability (Fig.2).  A 5.5x11 mm IBS implant is placed with < 35 Ncm (Fig.3).  Allograft is placed mesial to the implant (Fig.3 ^, 4 *).  The mesial ridge looks higher after suturing (Fig.5) than preop (Fig.1).  The wound dehisces 12 days postop (Fig.6 ^), which may be related to loss of graft meisally 3 months postop (Fig.7 <).  It seems less likely for the wound to dehisce if a large abutment is placed, because of less tension.  Hexa abutment 6.5x5.5(4) mm is placed (Fig.8), but due to the undercut distal to the tooth #20 (*), an angled abutment (4.5x15 degree 2 mm cuff) is used before final impression.  Final torque for the abutment is 35 Ncm.  The crown is dislodged <1 month post cementation.  It appears that the abutment screw fractures.  Is there a specific kit to remove the screw?

In fact the crown and abutment dislodgement is due to screw loosening.  After tightening, the crown is stable.  Occlusion is adjusted. After 2nd retightening, the patient reduces mastication force and implant crown delivery at #3, screwing loosening does not recur.  Bone density around the implant appears to increase (Fig.9 (9 months post cementation)) and continues to do so 2 years 2 months post cementation (Fig.10 *).  However the crown looks too large for the implant (lollipop).  In fact the crown dislodges 3 years 6 months post cementation, because of a lollipop (small and long, angled) abutment; after abutment composite build up, the crown is incompletely cemented with slightly open distal contact (Fig.11).  The crown will be redone once it dislodges again.

Return to Lower Molar Multiple Tooth Immediate Implant 1st Year  3, 9, 23 导板病例  位点保存/导板

Xin Wei, DDS, PhD, MS 1st edition 11/16/2016, last revision 11/08/2020