Immediate Implant Re-Placement

Immediately after 7x17 mm tissue-level implant removal at #31, a 5.9 mm tap is inserted without stability.  Then a 6.4 mm one is tried with stability, but incompletely seated (Fig.1 (green dashed line: the original osteotomy; red dashed line: Inferior Alveolar Canal).  After using 5.9 mm drill and tap, a 5.9x8 mm SM implant is placed with <20 Ncm (Fig.2).  The implant becomes loose when a 6.8x4(6) mm cemented abutment is placed.  Pain control is poor.  Block anesthesia is administered.  Following testing with a 6.4 mm tap, a 6.4x8 mm implant is placed >30 Ncm (Fig.3), followed by the 6.8x4(6) mm abutment (A) and bone graft (*).  Sutures are placed; periodontal dressing is applied.

There is constant postop pain.  When the pain subsides, the abutment is found to be loose.  Three weeks postop, the mobile implant is removed.  The site is bone grafted as well as placement of collagen plug (Fig.4).

Six months post implant removal, the site will be formed flaplessly by using osteotomes, followed by taps.  Use a healing abutment or screw to reduce mico-movement.

Two months post implant removal, the socket appears to have healed and be ready for implant placement (5-6x7 mm IBS as lingual as possible, equi- or sub-creastal buccally, Fig.5).  Pack allograft in the buccal crest prior to implant placement and simply apply bone graft over the coronal threads of the implant to repair buccal plate defect. 

Three months post implant removal, the lingual and buccal soft tissue ridges (Fig.6 black and white *) are almost at the same level.  So are the hard tissue ridges, as palpation indicates.  In order to avoid implant failure for the third time, the tooth #3 with infection will be extracted first.

The patient will return for implant placement 4 months post implant removal.  Start osteotomy with Magic Split (for determination of buccolingual position), followed by 3 mm Magic Expander (ME) for 13 mm with 3.5 mm implant spacer (for mesiodistal position).  Take PA when a ME is stable.

Return to Lower Molar Immediate Implant, #28

Xin Wei, DDS, PhD, MS 1st edition 03/06/2017, last revision 01/19/2018