Immediate Implant on a Neighboring Tooth

Before working on the left right quadrant implant placement, the patient cannot touch the tooth #18.  Exam reveals buccal caries under retainer (Fig.1,2).  Since the tooth #15 (Fig3) is missing and the mesial root of #18 is curved (Fig.2s (sagittal) >), #18 is deemed nonsalvageable (Fig.3 X).  A 5x14 mm bone-level implant is placed at the site of #19 (distally and invading #18 mesial socket).  Bone harvested from #19 osteotomy will be placed in the mesial socket of the #18 (Fig.3 red circles), while the rest of the #18 sockets will be packed by collagen plug (blue rectangles).  If the insertion torque of #19 implant is high, an immediate provisional will be fabricated, which will be extended distally to seal #18 socket opening.  Perio dressing may be required for complete seal.

Since the ridge crest of #19 is narrow (Fig.4 between arrowheads), bone graft will be placed buccal to the implant (Fig.5 red circle).  Is the plan practical?

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Xin Wei, DDS, PhD, MS 1st edition 04/28/2015, last revision 05/08/2015