Narrow diameter implant in posterior region
A 23-year-old female patient reported to the Department of Periodontics and Oral Implantology with a chief complaint of missing tooth no. 46 [] for about 5 to 6 years. On clinical evaluation, it was found that the edentulous space in relation to tooth no. 46 was compromised due to drifting of the adjacent teeth and was measured to be about 7 mm at the cervical level and at the contact area the space was reduced []. The buccolingual width preoperative was 7 mm and the inter-occlusal distance was measured to be 6 mm. The patient was suggested orthodontic correction of drifted adjacent teeth to achieve space for placement of standard implant. The patient was unwilling for orthodontic intervention because of prolonged treatment duration. After discussing the pros and cons of the NDIs in the posterior region, the patient gave the consent for the same. Following thorough clinical [] and radiographic [] evaluation, it was decided to place a narrow diameter two-piece implant of size 3.0 × 13 mm.\nFollowing standard preparation protocol for implant surgery, local infiltration anesthesia lignocaine (1:80 000) was administered. Using a scalpel no. 15, a crestal incision was given and the full thickness flap was raised using a periosteal elevator. Osteotomy was started using the pilot drill of diameter 2.0 mm to a depth of 13 mm and parallelism was checked using a paralleling pin. The osteotomy was subsequently enlarged to 2.5 mm. A narrow diameter two-piece dental implant of size 3.0 × 13 mm was placed with good primary stability achieving a torque value of 45 Ncm []. Abutment was placed and trimmed to receive temporary restoration []. IRWL[] protocol was followed with no occlusal contact in centric occlusion and eccentric movements [Figures and ]. A 0.2% chlorhexidine mouth rinse was prescribed two/three times daily for two weeks following surgery; antibiotics and anti-inflammatory drugs were prescribed for 5 days.\nAfter uneventful healing of 3 months, the patient was evaluated clinically and radiologically. Soft tissue demonstrated satisfactory healing and intraoral periapical radiograph suggested no marginal bone loss after 3 months of healing process.\nThe temporary crown with abutment was removed and closed-tray transfer coping was placed and a radiograph was taken for analyzing the fit of the coping to the dental implant. A 1-mm shoulder narrow diameter abutment was transferred to the laboratory for milling and fabrication of metal coping prior to final prosthesis. The abutment and coping was tried in to check for marginal fit. Final porcelain-fused metal crown was placed [] with good emergence profile and radiograph revealed good marginal fit of the restoration [].\nThe patient was reviewed subsequently after 6 months clinically and radiographically [] with no bone loss. At one year, clinical evaluation revealed good soft tissue health and excellent emergence profile []; radiographic examination showed no marginal bone loss [].