Implants in Narrow Crest by Resection

The ridge between the teeth #19 and 22 is narrow.  After resectioning the crest at the sites of #20 and 21 for 3-4 mm (Fig.2 *), the crestal width increases to approximately 5 and 4 mm, respectively.  It appears that width may not increase substantially if resection continues.  The plan is to use 1 piece implants to reduce postop bone resorption.  Initial osteotomy is finished with 1.5 and 1.2 mm pilot drills at the depth of 12 mm (Fig.2).  Since there is 4-6 mm clearance from the underlying Inferior Alveolar Canal, the depth increases to 14 mm.

Fig.3 shows that while the 1.2 mm drill remains at #21, the osteotomy at #20 is finished with a 2.5 mm drill.  It seems that the crest cannot hold too big an implant. 

After placement of 3x14(4) and 2.5x14(4) mm 1-piece implants at the sites of #20 and 21, allograft and Osteogen are to be placed around the defect area (Fig.4 *).  These implants oppose an upper removable partial denture, although the patient plans to change to implant supported restoration in the future.  Splinted provisional is fabricated at #20 and 21 immediately.  The lower removable restoration has turned into one fixed one.

There is small degree of bone resorption between the implants 3 months postop (Fig.5 arrowhead) with the provisional in place (*).  Six months later, the tooth #19 needs an implant.

Return to Lower Premolar, Arch Immediate Implant, Posterior Immediate Provisional, Chinese

Xin Wei, DDS, PhD, MS 1st edition 01/04/2016, last revision 09/18/2017