Control Length of Implant In Graft Bone

A 63-year-old man is a diabetic with history of good control.  He masticates unilaterally with missing teeth #2,3 and 24 (Fig.1 (taken 5 years ago)).  The latter has been restored with an implant.  Last February the mesial root of the tooth #19 was found to have vertical fracture with bone loss until the base of the septum (Fig.2).  The bone available for implantation is ~7-8 mm after root fracture (Fig.3,4).  The initial osteotomy depth will be 7 mm (IS kit), followed by the calibrated parallel pin.  The latter determines how many millimeters of an implant will be surrounded by the graft bone (Fig.4,5 (green: implant length; pink: cuff; blue: abutment length)).  Since the buccal defect is severe with mesial root split (Fig.7 *), draw blood for PRF (2 large tubes).  To save the remaining septum, place 2 of 1-piece implants on the either side of the septum (compare Fig.6,8).  Take photos to compare buccal vs. lingual gingival recession.  Tell the patient that the tooth #20 may be nonsalvageable.  Since insurance preauthorization does not get approval for several times, the tooth #19 is extracted with socket preservation and periodontal dressing.  The latter dislodges in 1 day.  When the patient returns for follow up 4 days postop, the socket is exposed (Fig.9).  An immediate implant should have been placed to keep the graft in place.  PRF also helps.  In fact preauthorization letter arrived 1 day earlier.  It appears that guided surgery is indicated for limited bone height.  The bone graft appears to gain ~ 5 mm bone in 4 months (Fig.10), which allows to place a 5x8.5 mm implant (Fig.11).

Return to Lower Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table), Armaments, No Antibiotic (canceled)

Xin Wei, DDS, PhD, MS 1st edition 12/24/2017, last revision 08/21/2018