No Lingual Plate Encroach-ment

A 42-year-old man has been our patient for 3-4 years (Fig.1).  An asymptomatic fistula develops lingual to the tooth #21 (Fig.2).  An oblique fracture line appears to be next to a post (Fig.3 ^).  A 3.5x11.5 mm implant seems to be able to be placed immediately lingual to the thick lingual plate with guide (Fig.4 L).  No buccal deviation will occur with sufficient buccal gap.  Design of an immediate implant at #21 (coronal section, Fig.5).  In fact the root remains in place first (i.e., extract the crown first, Fig.5').  When osteotomy is done with the last drill 4x11.5 mm, there will be no deviation because of even counteraction between the buccal root and the lingual plate (Fig.6').  Then the root will be removed.  But the 4.5x11.5 mm implant may be deviated buccal because of implant engagement into the lingual plate without buccal counteraction.  Therefore, a 4x13 mm implant will be placed following 3.5x13 mm (last) drill.  The implant is placed between the mesial and distal walls (Fig.7 sagittal section).

No Deviation Clindamycin Surgery
Xin Wei, DDS, PhD, MS 1st edition 02/20/2020, last revision 06/15/2020