2nd Molar Implant Much Deeper than 1st Molar

After extraction of the 2nd molar with buccal fistula (Fig.1), osteotomy is initiated beyond the socket for 4 mm (Fig.2,3).  Following moving the osteotomy distal and sequential osteotomy, a 4.5x11.5 mm dummy implant is placed equicrestal buccally (Fig.4 ^) with stability; the dummy abutment is 6.5x5(4) mm.  A 5x11.5 mm (definitive) implant achieves .>20 Ncm insertion torque (Fig.5).  With placement of a 6.5x4(5) mm abutment, Vanilla (Fig.6 *) and Osteogen plug over the graft and in the socket of #32, periodontal dressing is applied.  The implant at the 2nd molar placed much deeper than the 1st molar seems to be risky in term of the Inferior Alveolar Canal (Fig.3-6 red dashed line).  Several carpules of anesthetics have to be administered in an infiltration manner for pain control.  Fortunately there is no postop paresthesia.  For an un-compliant patient, socket preservation is a better option.  The implant seems to have osteointegrated 4 months postop (Fig.7).

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Xin Wei, DDS, PhD, MS 1st edition 07/06/2018, last revision 11/15/2018