How to Prevent Immediate Implant Thread Exposure?

Fig.1 (preop intraoral photo) shows that the tooth #30 has severe occlusal wear, suggesting occlusal trauma leading to bone loss.  It is well recognized that to prevent implant thread exposure, an implant should be surrounded by bone 2 mm thick.  It is possible for this case, because the bone at the implant sites is wide (1,2).  The coronal portion of the implant (Fig.3 I) threads appears to be supported by less dense bone (*).  Mixture of autogenous bone, allograft and synthetic bone is placed where it is in need (Fig.5 *).  The gingiva is approximated following implantation (Fig.4) and protected by perio dressing (Fig.5 P).  The soft tissue heals normally 2 weeks postop (Fig.6).  Bone graft (Fig.7,8 *) appears to have grown into the implant threads (Fig.8 arrowheads) 5 months postop.  The implants remain stable and are ready for restoration.

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Xin Wei, DDS, PhD, MS 1st edition 12/28/2014, last revision 01/01/2017