Two Unexpected Implants

A 63-year-old man (MM) has lost #30 due to furca lesion for more than 10 years, while there is 2nd caries under #31 crown.   The symptom does not improve after sedative filling.  The patient suddenly agrees to have 2 implants to be placed (unexpected).  Existing PAs are used for implant design (Fig.1,2): 5x13 and 5x11.5 mm for #30 and 31, respectively.

As usual, the septum of the 2nd molar is thin.  Osteotomy is intended to be initiated in the middle of the septum after Metronidazole socket application.  It is quickly deviated to the mesial socket (Fig.3 black outline with a parallel pin).  As planned, two implants are placed with insertion torque ~ 50 Ncm (Fig.4).  Collagen plug (Fig.5 orange) is inserted in the apical portion of the distal socket (blue outline), while autogenous bone harvested during osteotomy is mixed with Osteogen (Hydroxyapatite) and placed in the remaining sockets as well as in the mesiobuccal aspect of the implant at #30 (red circles).

Emergency implantation is more likely associated with imperfection.  The implant at #30 is placed slightly distal (compare the white lines and measurements in Fig.2, 5).  When the crown of #31 is removed, the position of #30 initial osteotomy site tends to be distal.

Anyway, abutments are immediately placed (7.5x5(2), 7.5x4(3) mm) and splinted immediate provisional is fabricated.

The patient returns for final restoration 3.5 months postop; it appears that the mesial and distal sockets of the site of #31 decrease in size and increase in bone density (Fig.6).  Five months post crown cementation, the tooth #12 becomes symptomatic.

There are no sockets at #31 11.5 months post cementation (Fig.7).  There are no sockets at #31 11.5 months post cementation (Fig.7).  The cortex forms between the implants 3 years 9 months post cementation, but caries is not detected (Fig.8 *).  The crown #32 dislodges 10 months later.  The tooth is extracted without bone graft because of being far from the nearby implant.

Return to Lower Molar Immediate Implant Plug 12/13 Xin Wei, DDS, PhD, MS 1st edition 09/21/2015, last revision 11/16/2019