Difficulty Associated with Non-Immediate Implant at 2nd Molar

The patient refuses to return to clinic to take PA prior to surgery.  When the preop PA is taken, it is difficult to place the sensor deep.  The PA shows one border of the Inferior Alveolar Canal, most likely the inferior one (Fig.1 arrowheads).  Since the canal is ~ 3 mm thick, there should be an extra 2 mm clearance (Fig.2).  Infiltration anesthesia is administered first; a 10 mm osteotomy is made initially (Fig.3).  The clearance appears to be not enough.  The length of the osteotomy is reduced to 8 mm.  By the time a 5.3x8 mm drill with stopper (Fig.4 *) is placed, the clearance appears to be sufficient.  Finally an extra wide implant (5.9x8 mm) is placed with insertion torque > 60 Ncm (Fig.5). 

The severity of supraeruption of the tooth #2 is felt while an immediate provisional is being fabricated.  The shortest abutment with the shortest cuff (6.8x4(1) mm) is chosen with occlusal adjustment of the abutment and the opposing tooth.  The immediate provisional seems mandatory.  It keeps the gingiva from growing and covering the margin of the abutment!  There is no paresthesia postop.  There is no bone resorption 4 months postop (Fig.6).  Density of the bone around the coronal implant threads increases 1 year 9 months post cementation (Fig.7).  The implant functions 3.5 years post cementation (Fig.8).

Return to Lower Molar Immediate Implant 15 14 18 Xin Wei, DDS, PhD, MS 1st edition 05/30/2015, last revision 02/28/2020