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Implant after extraction of first molar
The opinions within this web page are not ours. Authors have been credited for the individual posts where they are. Photos courtesy Terry Pannkuk - ROOTS
From: Terry Pannkuk To: ROOTS Sent: Tuesday, February 03, 2009 10:43 PM Subject: [roots] Yesterday's Implant This implant was placed 6 months after I extracted the first molar. The 2nd molar had been extracted 8 years ago. The patient did not want to go for 2 implants which would have been a bit more ideal utilizing the excellent bone in the 2nd molar area (edentulous for 8 years). This was not a spinner but very light torque....maybe 15 at best. When I hand tightened the cover screw it did not turn and I could put all the force I could muster and it wouldn't budge. I feel that it's ok, but still no healing cap and I buried it. Using the tissue punch after the initial twist drill gave me good visibility when developing the osteotomy site which was very helpful to visualize the bone. Tapped the sinus about 3.5 mm into it last using a 4.5 off-angle osteotome, no foo foo and then placed a 5.0 x 11.5 NBC Replace select. I'm very happy with the placement and angulation. The reslutant crown occlusion will hopefully capture just a bit of the mandibular second molar to keep it from supererupting over time. It hasn't so far since I extracted the max. 1st. M. There was a weird little snafu with the 5.0 NBC implant drivers both short and long. They wouldnt' fit into the osseoset handpiece because of some shank irregularity. When I looked at them under the scope there was no corrosion and there was no problem with any of the other drills. I finally had to break out a new driver from the pack but all I had was a long and this woman was very petite with limited openning. I'm going to read my Nobe Biocare Rep the riot act. It was a clumsy treatment but it went well. Once I got the implant started I put the weird driver in the torque wrench and tightened it the rest of the way by hand which is how I normally do it. All in all, I'm happy with this case. It took quite a bit of finesse to position the implant in the ideal position, with the minimal torque, it didn't slide off path at all. I make surgical guides for all cases but sometimes I don't use them much. In this case I needed it only for the intial precision drill penetration. Once ideal alignment and depth was validated, the guide is discarded and the larger drills are used. The guide tends to be a problem in cases of limited jaw opening and tight posterior access like this one. The sinus tapping likely pushes some nice, loose, chipped autogenous bone up against the Schnederian membrane as it tents it up. I don't push the envelope much further than 3mm of tapping into the sinus to avoid potential ripping. If I feel that I need more than that I flap and perform an open sinus lift - TerryTerry, would you consider tapered implant - to achieve better primary stability/insertion torque? - Dmitri Terry, what is your surgical guide technique? Are you still doing suck downs on a wax up and cutting an access hole in the suckdown for the osteotomy drill? - Dan Shalkey No, straight are better. I try to avoid tapered implants when possible. Better surface area and stability with straight - Terry
