1-Piece Implant at Molar with Narrow Ridge

Incision reveals a narrow ridge and a narrow mesiodistal space at #30 (Fig.1).  It seems that a 1-piece implant is indicated.  Due to limited mouth opening, a 1.2 mm drill is unstable in place after use for 10 mm; instead a 1.5 mm drill is able to be inserted for 8 mm (Fig.2).  A 3x10(2) mm 1-piece dummy implant is placed with 40 Ncm at an apparently acceptable level (Fig.3 >).  Clinically a few threads are exposed buccally.  When a definitive implant with the same dimension is inserted with 45 Ncm, it looks seated too deep (Fig.4,5).  The latter is noted after suturing.  The implant is backed up for a few turns so that the length of the abutment appears a little more reasonable.  Introspectively, a 4 mm cuff should have been used after ridge reduction.  Although there is no bone loss 4 months postop (Fig.6), the abutment margin (Fig.7 arrow) is subgingival (red dashed line: gingival margin).  Diode laser is used for gingivectomy prior to impression.  The bone density around the implant increases 11 months post cementation (Fig.8 *), probably related to recurrent #18 infection.  The patient uses floss after meal.

Return to Lower Molar Immediate Implant, IBS, #19,  Xin Wei, DDS, PhD, MS 1st edition 07/14/2017, last revision 03/16/2019