A 57-year-old woman has a 20-year-old loose FPD (fixed partial denture, Fig.1,3).  Upon Alginate impression for stent, the 6-unit FPD was dislodged with the exfoliated abutment at #27.  After removal of calculus from the root of #27, the FPD was placed in situ and temporarily cemented to #22 abutment.  When the patient returns, remove the FPD, treat the socket of #27 with Clindamycin, place implants at #23, 25 and 27 and fabricate a 6-unit provisional FPD.  At definitive stage of restoration, fabricate a 4-unit FPD at #24-26 and a single unit at #27.  Since bone loss is more severe mesiobuccally at #27 (Fig.1), place an implant as lingual as possible, but slightly more mesially.  If the defect is so severe that the implant (green) has to be placed deep, the abutment margin with the longest cuff (5 mm, pink) is less likely to contact the distal crest (*).  The bone may be low in density.  Consider underprep.

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Xin Wei, DDS, PhD, MS 1st edition 01/29/2017, last revision 05/12/2020