Safety is Priority

The lower right 2nd molar of a 50-year-old lady is non-salvageable (Fig.1,2).  The distance between the gingival margin and the upper border of the Inferior Alveolar Canal (IAC, Fig.3 red line) is 20 mm.  It should be safe to place a 17 mm tissue-level implant.  Is it safer or overcautious to place a 14 mm one (Fig.4)?

To increase safety further, ask the patient to take an oral antibiotic 2-3 days preop.  Insert a pilot drill at 14 mm, take a PA and measure the distance to IAC.  Finish osteotomy 14 mm deep first.  If stability of the last tap is questionable, extend osteotomy by 3 mm.

In fact, CT was taken 2 years earlier.  Sagittal section (Fig.5) shows that a severe miscalculation occurs (as compared to Fig.3).  The distance between the gingival margin and the lower border of IAC is 20 mm.  A 14 mm long implant is appropriate!  Coronal section demonstrates that the alveolus is wide enough to hold a 7 mm wide implant with more than 2 mm thick bone on either side (Fig.6).  How is the surgery?

Return to Lower Molar Immediate Implant

Xin Wei, DDS, PhD, MS 1st edition 12/22/2014, last revision 12/31/2014