#9 recurrent decay around an old crown, #10 non restorable:
Normally I like to extract first and then scan, but I was working this patient in as an emergency implant, so we made the radiographic guide and scanned:
Planned my implant to emerge from the Cingulum and to be able to use a stock abutment. Went back and forth with a 3.5 vs a 4.3. The Gap on a 3.5 was huge, so I planned for a 4.3 but would see what things looked like when I approached the 3.5. When you tip the platform palatal, the apex goes buccal, so make sure you are using a tapered implant and you mind the buccal:
Planned my implant too apical! Look at the inverted drill body. You need at least 5mm from the top of the guide to the base of the ref body. What to do?
By either placing your implant more coronal, or using a longer drill you can get this right. In this case I left my implant alone, but used the 16mm drills and changed the D2 from 22 to 25, mucho better-o!
Milled out the parts and pieces, again loving that Mach 2 scannable!:
Removed the tooth and started with the pilot. As per some recommendations from friends I bought a set of periotomes vs my trusty Luxators, which are gentle, but still can really expand the socket:
PLaced my pilot in the socket, again I use this as a “direction indicator” I want the screw access through the cingulum, I want the facial profile of the abutment to be similar to the adjacent teeth, and I want my implant to be centered mesio distally. Looks pretty close:
Final 3.5 through the Guide, RP free hand:
4.3 by 13mm. I know, I know..its big for a lateral, but I would not get the stability I needed from a 3.5.
Implant placed, I ended up using the 4.3, I usually like the 3.5 for laterals, but you can see that even with the 5mm diameter mount we still have a large gap on the buccal:
Went with a titanium stock Implant Direct abutment, you can see that even with the emergence profile, I have at least 1mm on either side. No prepping needed:
I know, I need to work on my temps. In the PA I look really close to the canine, but keep in mind that there is a curvature to the arch and the canine gets superimposed over the lateral. There is some controversy about attaching TEMPORARIES to natural teeth. And although its a rarity that I would connect an implant to the natural dentition (I have done this with semi precision attachments in some cases with anecdotal success), I will sometimes connect an implant temp to an adjacent tooth temp, while really opening the intaligo of the implant temp and using a cement like temp bond for “cushion” to make up for the disparity in the PDL of the tooth and the absence of it on an implant.