D1 Bone

The ridge at the sites of #29 and 30 is wide (Fig.1).  The bone density at #30 is so high that the initial depth is reduced from 14 mm to 10 mm (Fig.2).  To place a 5x10 mm implant at #30, a 5x12 mm and 5.3x8 mm drills have to be used to finish osteotomy (overprep, Fig.3).  The implants at #29 (4.5x10 mm, following 4.5x12 mm drill) and #30 have insertion torque > 50 Ncm.  Autogenous bone (*)is placed around the abutments (5.8x4(4.5) and 6.8x4(4.5) mm at #29 and 30, respectively).  After suturing, periodontal dressing is applied.  There is insufficient clearance between #31 abutment and #3 residual roots 8 months postop (Fig.4).   It appears that the abutment cuff and height should be reduced at #30 while an immediate implant is being placed at #3.

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Xin Wei, DDS, PhD, MS 1st edition 03/07/2017, last revision 12/06/2017