Severely Uneven Buccal and Lingual Crests

A 58-year-old man develops severe pain with mobility after the tooth #29 is uprighted orthodontically with the implant at #28 as an anchorage (Fig.1).   After extraction, the buccal crest (Fig.2 black ^) is confirmed to be lower than the lingual one (white ^).  Following insertion of a parallel pin (Fig.3), the osteotomy is moved distally with Lindamann bur.  Because of the severe discrepancy of the buccal and lingual crests, a 4.5x10 mm bone-level implant is placed even with the buccal one (Fig.4 ^) to reduce possibility of developing peri-implantitis.  An abutment (A) with a 5 mm-long cuff is placed for an immediate provisional.

The implant has to be placed more apically, because there is not much buccal gap after the implant is placed.  The latter is in turn due to the fact of failure to place the implant lingually (poor visibility, dense lingual bone).

The implant becomes infected and loose 14 days postop.  It is removed, curetted and bone grafted with collagen plug.

Four months and a half post #29 implant failure, the patient will return for #29 and 30 implant placement.  A stent has been fabricated for this purpose.  Crowns have been cemented at #28 and 31.

If the ridge is wide, flapless approach is adopted.  Start osteotomy through stent.  Initial depth will be 12 and 14 mm for #29 and 30 (gingival level), respectively (Fig.5).

Return to Lower Premolar Immediate Implant, IBS, Antibiotic, Improvement

Xin Wei, DDS, PhD, MS 1st edition 10/07/2016, last revision 03/07/2017