Case of the Week: A Straightforward Implant Case on Tooth #30

hi there I want to welcome everybody

back for another case of the week here

on chairside live and I want to present

this case to the practitioners again

that want to incorporate implant

dentistry into their practice obviously

I've done this in the past where I've

presented cases where that are ideal in

this situation the patient is missing

tooth number 30 so I bring the patient

in initially for a consultation and

examination obviously I want to use my

radiographs and a comb beam CT scan to

take measurements so that I know what

size implant I want to place in this

area and the CT scans are very

accessible pretty much everyone in

private practice and it's a good tool to

have so after the diagnosis and

treatment planning I'll bring the

patient back the following visit and

we'll go ahead and start the treatment

and what I usually like to do is reflect

the full thickness flap the flap design

is really based on where you have your

miko gingival junction and the

keratinized tissue on the buckle of the

tooth or the area that you're placing

the implant and you could design it so

that you can create a little bit more

keratinized tissue with the healing if

you need to in this situation it was a

straight forward flap design crystal

incision and I can go ahead and access

the bone and I want to create a flap

that's big enough that I can actually

visualize not just the top of the bone

or the occlusal surface area but also

buccal e and and a little bit of the

lingual as well so that I know where my

undercuts are and I can go ahead and

create my osteotomy so the flap is

reflected and I'll go ahead and remove

any residual soft tissue and then I'll

start with my start drill now usually

what I'd like to do is create that

initial osteotomy with the start drill

and then take the parallel pin and place

it into the osteotomy site and take a

radiograph this will kind of help me

gauge the direction of this implant and

whether I'm going in the right direction

or not both visually I can look at it

and say you know this parallel pin is

coming out exactly where I want my screw

access hole if I'm placing a screw

routine final restoration if it's not

then I can make a dress

with every subsequent drill that I'm

gonna be using moving forward so in this

case I move to the next osteotomy drill

and then I follow that up with the

shaping drill which you see here it's

important to use irrigation when you're

using the shaping drills so that you

don't cause any necrosis of the bone the

RPM I use is between 800 to 1200 rpm and

I'll go slowly and create my osteotomy

in order for the area to receive the

implant now what I do is as I move up in

size with the shaping drills I want to

use my parallel pen again to make sure

that I'm going in the right direction as

you can see here I'm not so now I have a

chance with the next shaping drill to up

right in the area and make sure that I

can place the implant in the proper

position so now I can lean my shaping

drill to the direction where I want to

create that osteotomy and this technique

gives me a chance to place the implant

in the proper position so once I'm

confident that I've created the

osteotomy and it's in the right

direction then I can move forward and

place my implant so there you have a

view of word the osteotomy is and I'll

go ahead and load the implant with the

implant driver onto the torque wrench

and I'll place that directly into the

osteotomy site and I'll start to thread

the implant into the bone so very

straightforward procedure you can also

do this with the handpiece and the

handpiece has to be turned down to 25 to

35 rpm so that you're placing the

implant slowly and I feel confident with

the torque wrench in this situation and

that's what I used and this implant is

bone level implants those designed to be

placed at the level of the bone

sometimes on the lingual the bone level

might be a little bit higher than the

buccal and that'll show on the

radiograph I elected to do a one-stage

procedure where I want to use a healing

abutment and not a cover screw so

healing abutment goes through the tissue

the tissue heals around it and you don't

have to come back and uncover the

implant and once the cover screw is on

there I'll go ahead and place a couple

of interrupted sutures in this situation


again a chromic suture and as you can

see here in approximately I had plenty

of space to have the implant from the

proper position and with the final

radiograph you can see that I was able

to further upright that implant and

place it in proper position for the

final restoration so another case where

if you're incorporating implant

dentistry into your practice this case

would be ideal because there's plenty of

bone in approximately means you distally

buccal lingual II and also the nerve is

far enough away from the apex of the

roots and the implant where I can feel

confident that I can place that implant

without hurting the patient so thank you

for joining me for another case of the

week and hope to see you back here in

the near future