Plan Ahead for Abutment

Mr. Soh, 51-year-old, is a heavy grinder, breaking #19 roots with RCT a year ago (Fig.1,2).  Now the tooth #18 is symptomatic and mobile.  If the septum is not destroyed after extraction (Clindamycin), use 10 mm stopper for depth control.  If it is absent, osteotomy is 3-4 mm beyond the apex (Fig.1: 3.78 mm).  If the socket can hold 5 or 5.5 mm implant, place a pre-mounted one (Fig.2). 

Since there is gingival recession postop, choose an abutment with short cuff (e.g. 2 mm in Fig.2) so that there will be less likelihood to change the abutment later on.  The diameter of the abutment should be as large as possible to close the socket.  It is better to place bone graft prior to abutment insertion.  Polish the lower portion of the immediate provisional (contacting the gingiva) well. 

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Xin Wei, DDS, PhD, MS 1st edition 03/31/2016, last revision 04/12/2016