From: Terry Pannkuk
To: ROOTS
Sent: Thursday, August 06, 2009 4:43 AM
Subject: [roots] Cracked Tooth Replacement

Here's an interesting example of why I like a surgical guide with a bit of flexibility.  There was a pneumatized
coronally extending portion of the sinus on the distal.  Needing 1.5mm of bone from each adjacent natural tooth,
an Astra 4.0 was planned. The initial placement of the guide pin revealed that it was a bit shifted toward the
distal pneumatized sinus area.  I simply tilted the angle of first penetration of the precision drill a bit
mesially and took a check radiograph.  I was happy with the alignment knowing it was nicely parallel to the root
of the second bicuspid and pretty much parallel to the wall of the pnematized sinus on the distal. The 2.5 and
3.2 drills went to the desired length with no need for sinus tapping. I then drilled half way down with the
3.7 drill and tapped the ledge down with the 2.5, 3.0, and 3.5 ostetomes.  I tapped 3/4 of the way down with
the 4.0 osteotome and screwed in a 4.0 x 9mm straight Astra.  Of course no taper. :)  I bury most of these
implants without a healing cap figuring it takes some additional slight risk out of the equation.  It's no big deal
to punch the tissue out and place the abutment later - Terry




Very nice terry !! Can you take a photo of the kind of surgical guide you used here - sergio