Implant Placement at #45 with Orthodontic Wire Adjustment
Surgical Procedure
Chief Complaint
Missing lower right premolar (#45) requiring implant replacement.
Clinical Findings
Edentulous #45 site
Ongoing orthodontic treatment with upper and lower archwires in place
Adequate ridge volume for implant placement
CBCT confirmed suitable anatomy and safe distance from IDN
Treatment Plan
Implant placement at #45
Dual abutment placement for soft-tissue shaping
Primary closure
Adjustment and reactivation of orthodontic mechanics post-surgery
Post-operative CBCT verification
Pre-operative Assessment
CBCT reviewed
Risks and procedural steps explained
Implant position planned
Patient and parents understood and consented
Informed consent obtained for implant placement at #45
Anesthesia
Local anesthesia.
Surgical Procedure
Patient cleaned and draped
Orthodontic wires removed from both arches
Incision made; buccal flap raised
Osteotomy prepared with implant drills
Dentium Superline III implant (5.0 × 10.0 mm) placed at #45
Dual abutment 5.5 mm (M) with 2.5 mm gingival height attached
Flap released
BSS × 4 placed for primary closure
Hemostasis achieved; POI given
Orthodontic Mechanics Reset Post-Surgery:
Upper Arch:
↑ 19×25 SS
Closed chain (Silver) #17 ↔ #27
Figure-8 tie (Silver)
Lower Arch:
↓ 19×25 SS
15 mm open coil spring placed between #44 & #46
Closed chain (Silver) #44 ↔ #37
Figure-8 tie (Silver)
Post-operative Assessment
Post-op CBCT confirmed implant well-positioned
IDN intact and uninvolved
Patient satisfied with outcome