working safely above the foramen
DESCRIPTION
48 year old female with failed abutment molar. Molar removed and site grafted. Mandibular canal and foramen are visible on simple PA radiograph. 8 mm implants should just work. Precise depth drilling with confirmation at reduced drill depth allow secure operation above critical structures. No need for CBCT. At placement additional grafting allow for increase of keratinized tissues.TRANSCRIPT
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Categories ; Posterior, Grafting, Multiple implants, Blue Sky Bio
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Failing abutment molar
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Failing abutment molar
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Extraction, non resorbable PTFE membrane
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At 3 weeks
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At 3 weeks
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At 3 months post extraction, cast based planning
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Screw retained crown setup
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Perfect but tight fit for two 4 mm impants
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Cross bars removed
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Two 8 mm implants planned. Note close proximation to mental foramen on X ray
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No need for rotational adjustment, so use green 0 degree rotation blocks
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Flapped access allowing for grafting hard and soft tissue
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18.7 mm drill shortened with green flexistop to evaluate distance to foramen
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Length pins used to evaluate that indeed an 8 mm implant is OK, prep not yet to
full length
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Additional 1.5 mm OK to prep deeper at # 29 implant above foramen. Check
twice drill once
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Prep now to full length
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Nobel Biocare starter drill used to flatten top of ridge.
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3.2 mm Astra facilitate drill
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3.7 MM Astra facilitate drill reduced length with 3 mm flexistop for stepped back
preparation. 18 – 3 – 10 = 5 mm
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Confirmation
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Gentamycin antibiotic eyedrops
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Blue Sky Bio Conus implant 8 x 4 mm. Carrier set for guided depth control
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Implants placed as planned, note local buccal tread exposed on # 29 implant
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Bone chip harvest
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Bone chip placed
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Protected with non resorbing bio-oss
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Mucograft to increase keratinized tissue
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Implants placed as planned
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Implants placed as planned
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3 weeks post placement, note increase in buccal attached tissues