Mesial Shift

A 58-year-old man has history of temporomandibular joint disorder as related to severe occlusal breakdown and missing tooth #18 (Fig.1,4).  The tooth #29 is also missing; the tooth #30 has shifted and tilted mesial.  Severe pain develops at #30 two years after MOL composite (Fig.3).  The patient insists on extraction and implant, although pulpotomy has been done to alleviate the pain.  Although there is sufficient bone height, IS implants will be used because of primary stability and apparent better implant/abutment binding as compared to IBS (with tendency of screw loosening).  Osteotomy will be initiated in the mesial socket at #30.  Measure the whole length of drills.  Find 17-8 mm mark, which will be used as soft tissue landmark.

Since the bone density at #30 is low, underprepare the site #18.  The depth will be 15 mm with flapless technique.  Prepare Magic Split and Expanders. 

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Xin Wei, DDS, PhD, MS 1st edition 12/24/2017, last revision 08/23/2018