This is so old hat I almost didn’t post, but haven’t done an implant since last week, so here is a step by step walkthrough of a very simple, non guided immediate molar with a 7mm HA coated Legacy 2. I did the RCT/Buildup and CEREC about 8 years ago and now the patient has pain and some swelling in the inter proximal. Found the MB2 all canals obturated to the apex. So I gave the patient a choice. I did not want to do the retreat, as the RCT was good and I just did not think I could improve on it. The patient could either get the retreat/ second opinion from endo, or we could just pull it and do an implant. The patient opted for the latter. I had an hour, and I was leaving to board a plane lecture in a few hours and if you have ever been to LA you know it takes a while to get to LAX, so I opted for non guided as it was pretty cut and dry.
You all know the deal. Take a surgical 557 to the furcation after leveling the tooth to the gum line. Make the hole big enough for your 2.3mm pilot. Let the dentin of the roots guide your drill into the bone of the furcation.
Take a film and or picture of the angulation pin in the furcation because, well, its just awesome! After confirming you have a good “glide path” for subsequent drills, section the tooth and remove the roots then proceed with the drill sequence. In this case we are using a 7mm Legacy 2 implant so as you may know we drill up to the 5.4mm drill then go to the very large crestal bone drill to shape the socket.
I just like HA coated for any immediate molar or any D3 or D4 bone. Crazy amounts of stability, I tolerate greater than 50 Ncm when dealing with these as the buccal and palatal plates are just so thick and I need all the stability I can get. Note the very large gap distance around the implant so we know we are going to have to fill that in with some DFDBA and a membrane.
Yawn. If you are a IME reader you know the deal by now. Pack your graft, poke a hole in the membrane with the surgical 557 and use a 5.7mm healing abutment (I love contour healers but they tend to bunch up the membrane). Sutured as tight as I could with gut. Patient will return in about 6 months to restore.
4 months later. Scanned in 4.3 with a TSV 5.7 Scan post which is compatible with the Legacy 5.7-7mm implants. Usually I replace the cylindrical healing cap with a contour healer, but we couldn’t get in him in.
Designed the crown. For some reason I really had to adjust the occlusion so the anatomy got obliterated. Put it back in before sintering and glazing.
Crown in place. A little teflon tape, composite and stain,