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Categories ; Anterior, Flapless, Grafting, Multiple implants, Immediate
placement, Nobel Biocare
Courtesy of : Aparna Subramanian, prosthodontist San Francisco, CA
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Active infection # 10, Incisive foramen of significance
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BLP set for screw retained crown
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BLP for screw retained crown. 2 mm buccal resorbtion anticipated, note line
drawn 2 mm from current buccal contour
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Regular Diameter for # 9, Narrow Diameter for # 10
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Wings are fitting well without crowding. In certain cases it might be needed to
make two distinct individual surgical guides, i.o, one.
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Note that implants are not in line, but positions are dictated by the desired
prosthetic outcome
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Removal of root and debridement of socket
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Harvesting of “ free “ connective tissue
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Radiograph is diagnostic for # 9 site, note foramen. A 3 degree rotation block is
selected to clear foramen
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# 10 radiograph is diagnostic, set up is accepted
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2 mm twist drill at 10 mm, the decision is made to increase the rotation to 7
degree, with a red rotation-block to increase the safety margin with the foramen
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Nobel Active 4.3 x 10 MM is placed
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The “ free “ connective tissue is grafted to augment the buccal
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2 mm twist drill
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The decision is made to rotate 3 degrees with a yellow rotation-block
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Guided tap
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Nobel Active 3.5 x 10 in the # 10 site @ 50 N/ cm , Note that # 9 has a similar
inclination as the natural root of # 8, clearing the incisive foramen
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Osteotomy # 10
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Alveolus # 10
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Implant # 9
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Grafting with minimally resorbable Bio-Oss, aiming to maintain maximal buccal
contour
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Collaplug + cyano acrylate tissue glue
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One week post operative