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Endo tips    Better Endo    Endo abstracts    Endo discussions

Implant case - Courtesy ROOTS

From: gary l. henkel d.d.s.
Sent: Tuesday, March 20, 2007 1:36 AM
Subject: [implants] case from this afternoon

This was a straight forward case we just placed this afternoon 
using the deplaque nested guide components.  Since this
was a second molar, the greatest challenge was vertical dimension.  
Patient was a trooper and did an excellent job. Although this was 
not a cone beam scan, note how close the final placement comes to 
the original planned position. Implant is a 5.0x11.5 prima connex 
- Gary



Gary, Why use a tapered implant?  or is it irrelevant? - KendelG

Good question.  the answer in this location is i could have easily 
gone with either, but i've recently gone more to tapers as i find 
them a little more universally applicable. specifically:

1.Where space is tight between adjacent roots, i may be able to get 
  a taper in where a parallel wall wouldn't fit

2.in situations where there might be a significant lingual undercut, 
  as in my current case, or a buccal undercut, say   in a congenitally 
  missing lateral, you can avoid fenestration (windowing) the bone.

3.in immediate load situations, they can provide more initial 
  stabilization as they "wedge" themselves as you tighten them

4.in sinus lifts, the same wedging can provide better stabilization in 
  the limited bone height that is available

5.one can undersize an osteotomy to provide greater stabilization from 
  the lateral wedging affect.

what is the bad news.

1. all else being equal, a 5x10 taper provides 20-30 percent less 
   surface area to bone than a 5x10 parallel wall
2. you need to make the osteotomy a little deeper than the planned 
   placement.  if you bottom out the tip of the implant, you can strip 
   the threads.

both work, but these are the general guidelines.

in this case i primarily chose the fixture as it was the correct 
length and width for my application.  i have so damn many fixtures 
in inventory, some of which i use once in a blue moon, i've been 
trying to consolidate my supply and go a little leaner and meaner.  
not scientific, but reality - Gary

Cool info--thank you Gary! - KendelG

Perfect placement Gary.  if I may add another reason to consider a 
taper fixture in a lower 2nd molar site.... lingual concavity and
more risk of perforation with a parallel walled implant.
- Gregory Kurtzman

See #2  - Gary
K 3 lightspeed

Crown replacement

Root reinforcement

Vertical root fracture

Periodontal pocket

Cox crapification

Cold sensitivity

Buccal sinus

Nikon 995

Distal canals

Second mesial canal

Narrow escape

Membrane

Severe curvatures

Unusual resorption

Huge pulpstone

Molar access

Perforation repair

Maxillary molars

Protaper shaping

Pulsing pain

Apical periodontitis

Mesial middle

Isthmus protocol

Fragment beyond apex

Apical trifurcation

Jammed K file

Mesial canals

Irreversible pulpitis

Bicuspid abscess

Sideways molar

Red Dye allergy

Small mirrors

Calcified molar

Extraction and implants

Calcificated central

Internal resorption

Bone lucency

Porcelain inlay

Bone allograft