Here is, in my opinion, the perfect beginners case. Huge Ridge, tons of attached tissue, and a nerve practically 25mm from the crest. You guys know me and know I’m bananas about Guided Surgery, but I wanted to do this old school for the newbies out there planning their first cases:
Extracted and Grafted 2 months ago. Tons of good tissue, huge ridge in all dimensions:
Scanned the patient and thre in some .ssi files from CEREC just to get an idea of where the occlusion was:
Cut and dry case, did I need a CBCT? No, but more info is always better
I always go in with a ligmaject prior to laying my flap. It lifts the periostoeum off the bone and keeps things tidy for the camera! Although I am laying a papilla sparing flap, I know ahead of time that I am using a healing abutment, so I went ahead and punched the tissue:
With flaps its easy to lose track of where you are mesio distally and bucco lingually so I used the Lance bur and did a “bulls eye” in the middle of my punch. Then I just placed two releasing incisions on either side of the punch so that I could visualize the ridge:
Lean your drill up against a molar if you are doing another one to get your angulation. We know that pre-molars lean to the buccal, while lower molars tip lingual:
I love the Verban Depth Gauge, it has platforms you can put on it so you can see where the final will end up:
You all know I am a fan of the Veban Drillstops, but I wanted to use the Zosseo stops for this case as I could show the newbies how, when using stops, you can go through the whole series of Implant Direct drills without worrying about length:
One of the nice things about the stops and keeping your releases close to the punch is that you have a nice mesio-distal guide on where to drill:
HA Coated 5.7 by 10. I could have gone longer, but I just did not have one in the drawer :}
Indexed, Big ‘Ol Cover Healing Cap, Sutured:
Case progression, God I love this stuff!
Back from the lab. Good emergence profile due to the 5.7. Due to the bone loss we are at about 5mm below the adjacent teeth CEJ, but overall good running room.
Good bone healing, on the side shot it looks like there is no attached tissue, but I think thats just a trick of the light as you can see the attachment in other shots.
Nice Tissue response, and in these images you can see a good amount of attachment.