Implant in Narrow Mesiodistal Dimension

A 56-year-old lady has lost #30 for long time with narrow mesiodistal width (Fig.1: ~ 8 mm).  A relatively narrow implant has to be used (4.5 mm).  It also fits buccolingually (Fig.1': CT coronal section).  With implant within the bone, postop bone resorption appears to be less severe than that at #18,19.

Osteotomy starts with a 1.5 mm drill at 11 mm bone level (Fig.2).  When a 4.5x17 mm tap is placed at 14 mm bone level after sequential osteotomy (Fig.4), the buccal plate seems to be present (Fig.3).  A drawback is the lingual position (Fig.5).  When the tap is removed, the buccal plate is thin (Fig.6).  A 4.5x17 mm tissue-level implant is placed (Fig.7: 60 Ncm).  Bone resorption starts crestatlly 4.5 months postop (Fig.8) and appears to get worse 1 year 3 months postop or 10 months post cementation (Fig.9).  However, cortical bone forms between the crest and implant threads 1 year 8 months post cementation (Fig.10 <).  The patient's main concern is that she does not have normal taste ever since she got the implants.

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Xin Wei, DDS, PhD, MS 1st edition 12/24/2015, last revision 07/04/2016