Panoramic X-ray

When the tooth #18 with mesiobuccal fistula (Fig.1 <) is extracted, the lingual septum (Fig.2 <) seems to present a hindrance to eradication of the periapical granulation tissue.  The septum is subsequently removed with a chisel.  A 2 mm drill is used to initiate osteotomy in the mesial socket, followed by inserting a parallel pin (Fig.3).  The latter is either incompletely inserted or displaced (from its osteotomy site, yellow dashed line) during X-ray taking because of 3 mm deep osteotomy.  After use of 4.8 mm Magic Drill, a 5 mm tap drill does not achieve stability, whereas a 5.5x9 mm dummy implant does (Fig.4).  A 5.5x11 mm IBS implant is placed with 50 Ncm with a 6x4(4) mm abutment and bone graft (Fig.5 *).  The Inferior Alveolar Canal, unclear in the last 2 PAs (Fig.4,5), is shown in the postop panoramic X-ray (Fig.6 red dashed line).  The immediate provisional and abutment dislodge 1.5 months postop (probably due to tight vertical space); since the socket has been reduced and healed (Fig.7 ^), a healing abutment is placed.  The implant seems to osteointegrate 3 months postop (Fig.8,9).  When the permanent crown is cemented 4 months postop, the buccal fistula is present.  The crown is loose 23 months post cementation.  Although the buccal fistula disappears, the buccal plate collapses.  BW taken post retightening shows increased bone density around the implant (Fig.10).

Return to Lower Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table) Xin Wei, DDS, PhD, MS 1st edition 07/25/2017, last revision 10/28/2019