Today i inserted imediat postextractional a Bredent copaSky 4x14, in socket 21, after a Root fracture in the middle.third.
The case was made using a radiologic surgical Guide. The extraction was perfect, without any bucal bone fracture, or trauma for the soft tissue.
The torque was poor around 25 Ncm. I tried to engaged more apically but stilul no high torque, stilll 20-25 Ncm.
I made buccal gbr with bone graft, prf, and CTG. The implant îs 5 mm bucal , drom the gingival margin, and 3 mm from.the buccal plate. I made a customed healing abutment.
Should i make.a maryland? Or reentry, remove the implant and put a megagen 4.5x13, and try to load?
Was a fully digital surgical guide used? Why did the implant appear to be placed too deep? Looking at Figure 2, the labial bone plate seems very intact. If I were performing the surgery, I would not raise a flap, but rather place bone graft material coronally in the jumping distance, compact it, and then perform a simple free gingival graft. As for the current situation, you could make a temporary denture with a transparent vacuum-formed spacer.
Could you remove the implant, place some fine small particle cancellous bone with a small syringe and then drive the implant in to a more superficial depth and get better primary stability?
Rather than remove-retraumatize why not leave it in place… I am still loyal to Zimmerr TSV which is an old school fixture design so I am not a faithful disciple of the “Zero Bone Loss” concept but this appears to be a fixture designed with this concept in mind. Given that “Zero Bone Loss” is so widely accepted and promised within the implant industry isn’t this an acceptable placement? It is only a problem if you experience circumferential bone loss around the fixture and per the manufacturers promise that will not happen here so you should be fine. Leave it and let the promise of the design handle the rest!!!
