Sufficient Vertical Space

Although there is buccal atrophy at the site of #30 (Fig.1 *), the vertical space is sufficient (Fig.2).  Instead of Magicore, a FC implant will be chosen.  Following initial osteotomy with 1.6 mm pilot drill at 11 mm (Fig.3), Marking Bur, 4.3 mm Magic Drill and Final Drill are used to finish the osteotomy.  A 5x11 mm IBS implant is placed with insertion torque of >45 Ncm, followed by insertion of a 6.5x4(2) mm abutment (Fig.4 A).  A small amount of mixture of autogenous bone and allograft (.5-1.0 mm) is placed over minimally exposed buccal implant thread, followed by collagen membrane.  Because of the presence of the abutment, the buccal and lingual flaps are approximated without tension (Fig.5).  The abutment also increases the retention of periodontal dressing.  The procedure is finished in a timely manner because of simplicity of osteotomy.

The periodontal dressing has dislodged for 2 weeks, ready for provisional.  Four weeks postop, the 6.5x4(2) pair abutment is found lingual and changed to angled one 5x2x15º.  After adjustment of the abutment height, temporarization is made with clearance.  The patient returns for final restoration 3.5 months postop; there is minimal crestal bone resorption (Fig.6).  The crown is recemented 1 year 4 months post cementation, most likely related to lingual placement (Fig.7).  The bony trabecular structures are more distinct and dense around the coronal end of the implant.

Return to Lower Molar Immediate Implant Xin Wei, DDS, PhD, MS 1st edition 12/02/2016, last revision 09/16/2018