CT Exam and Design for Immediate Implant
The radiolucency is more or less confined to the apical region. The fistula is most likely due to endo failure. The buccal and lingual canals fuse before exit. Debridement and filling were not done properly. Although root canal retreatment is an option, implant replacement offers long term prognosis.
It appears that there is a buccal bony defect coronally. The implant is placed more or less palatally (in position and tilt) for better restoration. Either bone level (4.5x14 mm, Fig.1) or tissue-level (4.5x20, Fig.2) implant is placed. The diameter is more or less determined by the adjacent teeth (Fig.3). A 4.5x14 mm bone level implant should obtain sufficient primary stability (Fig.4). If not, either the diameter or length of the implant is to be increased.
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Xin Wei, DDS, PhD, MS 1st edition 03/02/2014, last revision 01/19/2018