One-Week Immediate Loading with 5mm ALX Implant in Limited Bone Height

Case Summary 🔎

Patient Information

• Age/Sex: 66-year-old Male

• Systemic Condition: Currently taking medications for hyperlipidemia and depression

• Chief Complaint: “My lower right tooth is broken.”

Clinical Findings

• Tooth Sites: #45, #46

• Diagnosis:

  • #45: Missing tooth

  • #46: Chronic periodontitis

Treatment Plan & Outcome

• Placement of 5mm ALX implant

• Immediate loading protocol applied

• Final prosthesis delivered within 1 week

• Clinically stable outcome

Case Presentation

1️⃣ Pre-Op

• The original prosthesis consisted of five implants placed from #45 to #35, with pontics on #46, #47, and #36, #37, forming a hybrid-type restoration.

• The extended cantilever on #46 and #47 likely resulted in excessive occlusal loading on the opposing maxillary implants, leading to mechanical complications or fracture.

• Preoperative intraoral photograph

• The distance from the inferior alveolar nerve to sites #45 and #46 was 6 mm.

2️⃣ Surgery

Fig 1. Crestal incision and flap elevation to expose the alveolar ridge

Fig 2. 5 mm initial drill was used

Fig 3. Final drilling completed sequentially up to 4.5 × 5 mm

Fig 4. Implant position and angulation confirmed prior to insertion

Fig 5. Based on D113 bone density, a 5.5 MAXY drill was selected for site #46.

Fig 6. Drilling was performed to a depth of 5 mm using the 5.5 MAXY drill

Fig 7,8. Based on D113 bone density, a 5.5 MAXY drill was selected for site #47.

Fig 9. Drilling was performed to a depth of 5 mm using the 5.5 MAXY drill

Fig 10. Post-drilling image after application of MAXY drill

Fig 11. ALXIT35505WT implant placed at site #46

Fig 12. Implant insertion torque: 40 Ncm, ISTV: 77

Fig 13. ALXIT35505WT implant placed at site #47

Fig 14. Implant insertion torque: 40 Ncm, ISTV: 78

Fig 15. Alveolar ridge prior to bone grafting

Fig 16. Alveolar bone grafting using DM bone (HA6 : β-TCP4)

Fig 17. Application of collagen membrane over grafted site

Fig 18. Suturing completed

3️⃣ Post-Op

• Postoperative panoramic and periapical radiographs

• Scan body connected and intraoral scan performed on the day of surgery

4️⃣ Prosthetics - 1 Week Immediate Loading with Final Restoration

• Intraoral photo taken one week post-op, followed by removal of healing abutment

• Zirconia prosthesis delivered with occlusal adjustment and resin hole sealing completed

• Post-delivery panoramic radiograph taken after final prosthesis delivery

• Periapical radiograph taken 4 weeks postoperatively to assess healing

• Intraoral photograph taken 6 weeks postoperatively

• Periapical radiograph taken 6 weeks after surgery to evaluate implant stability

5️⃣ Before & After

1-Week Immediate Loading with ALX Fixture in Limited Vertical Bone Height

CMI fixation at #46 and #47 was performed using 5 mm short ALX implants due to the limited vertical bone height and 6 mm distance from the inferior alveolar canal. Despite the proximity to the nerve, ideal insertion torque was achieved thanks to the application of the MAXY drill in dense D113 alveolar bone. Final prosthesis was delivered just one week post-op, demonstrating successful immediate loading in a challenging case with limited vertical space.