This case shows the placement of two individual implants, each with different characteristics.
The upper one must be placed in the 15 bicuspid area. The bone has collapsed during resorption, although, externally, it doesn’t seem so.
The lower one must substitute a damaged 46 molar,which presents periapical abscess in both rots, bone loss in the septum and fistula draining to vestibule.
I start always by the easier part of each surgery. Which, in this case, is the upper implant.
After opening the flap I find a concave vestibular bone, with a ridge of about 4”, insufficient for placing a 3,75” with safety margin ridge bone on either side of the implant.
A smaller diameter implant could have been used, but this is a heavy duty area for chewing, and for me, the wider and longer the implant is, the better.
So, I expand the ridge to the limit of its elasticity in the desired angle. Again, I could have chosen another angle for insertion, but the more vertical, the better long term expectancy, especially in single, heavy loaded implants. You can appreciate the vestibular groove due to the concavity, angle of insertion and elasticity limit.
I place a 4×15” 3i implant and proceed to cover the bone defect with Bio-Oss bone graft and Bio-guide resorbable collagen membrane fixed by the healing screw.
The lower molar, after extraction, leaves a wide crater, wide septum resorption, as expected by x-rays, and a thin, cracked by the extraction, vestibular wall, through which the fistula was draining out.
I prefer to postpone the implant placement for a second phase. By now, I clean the alveolus thoroughly, removing all soft tissue, fill it up with Bio-Oss bone graft and Bio-guide resorbable collagen membrane, and try to close it as much as possible with the flap.
Four months later we check X-rays and see the shadow of the new generating bone in the alveolus.
Ridge preserved in height and width, the placement is now simple.