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Categories ; Posterior, Grafting, Multiple Implants, Nobel Biocare

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Patient reports loss of two molars about 1 year ago

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Molar site appears to have grafting material

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Mandibular canal identified on PA radiograph

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Two implants planned

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# 19 site # 18 site

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BLP’s placed in relation to bone volume, bone width and screw retained crowns.

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BLP’s lock in the bucco-lingual and shoulder of the implants

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Mesio-Distal ideal positioning

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BLP’s overlap sufficiently, radiograph is diagnostic , no need for correction, so 0-

degree rotation blocks ( green) are indicated

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Poor integration of graft material.

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# 18 site prepared for 8.5 mm implant

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# 18 , a 1.5 mm alveolectomy planned due to a pointy ridge. Note defect in # 19

site

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Due to failed bone graft, osteotomy has to be increased from planned 8.5 mm to

created adequate initial stability. 10 mm osteotomy ( 23 – 10 = 13 – red flexistop

@ 3 = 10 MM )

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11.5 mm osteotomy

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11.5 mm osteotomy, decision is made to increase to 13 mm, due to safe distance

to mandibular canal

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Note large defect around osteotomy # 19

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Prep and placement of 4.3 x 8.5 Nobel Active implant # 18 site. Using Astra

Facilitate drills.

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13 x 4.3 MM Nobel Active for # 19 site

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4-5 mm of implant exposed, buccal and lingual cortical plates are intact.

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Grafting with “ Socket Graft Putty”

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Covered with Resorbable collagen membrane for covered healing

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Implants placed in planned position, only # 19 is 4.5 mm longer to created

adequate initial stability