Tissue-level Tap for Bone-level Implant

A 33-year-old man had severe toothache associated with the distal caries of #31.  The impacted tooth #32 has been extracted.  Pulpotomy has been done for #31.  IRM fell out once due to large defect.  After discussion the patient agrees extraction of the #31 and immediate implant.

Fig.2 is an illustration after extraction of #31 and 32 to show the low distal crest (<).  The septum (S) is thick and as high as the mesial crest.

Osteotomy is initiated in the mesial socket (Fig.3 red line).  Depth is controlled at 14 mm (gingival margin).  Reamers are used until 3.5 mm.  Tatum tapered taps start with 4.5x17 mm (14 mm in depth) until stability is achieved and the mesial socket is almost filled.

Shift to bone-level implant, from 5x10 to 6x12 (Fig.4 green area).  The coronal portion of the septum may be moved distally due to taps.  The distal socket is packed with collagen dressing or plug (*).  An immediate provisional is anticipated for socket closure and graft/membrane containment.  Take a preop PA for depth measurement.

Return to Lower Molar Immediate Implant

Xin Wei, DDS, PhD, MS 1st edition 06/23/2015, last revision 06/25/2015