Dentaltown June 2018 - 34

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this was going to happen, like abnormally little bleeding, abnormally little bone on the flutes,
etc.? Just curious to figure out how to avoid this myself.
Coming as I do from the Bicon world, where we press-fit the implant and hence do not
strive to achieve any placement torque, I remind you that this implant could integrate if you
had it in the desired position. If it's too apical then yes, remove. But I don't know if grafting
and coming back in six months is a guarantee of high density bone in the site. Never seen
studies to support it. ■
3/13/2018

ljsdds
Member Since: 06/14/02
Post: 24 of 71

The long impression post is brilliant. Even if you have to use the 1557 to open things up.
Please keep us posted and I agree things like this can happen to anyone. Great advice (that I am
going to use) to probe for a firm bottom before dropping the implant in. ■
3/13/2018

palmers31
Member Since: 07/30/08
Post: 26 of 71

In hindsight, I suppose there wasn't a lot of bone in the flutes of the osteotomy former. But, I
was down to length according to the surgical guide, and I knew I didn't have a whole lot of apical
preparation, so I didn't think anything of it. No notable differences in bleeding.
I did not probe for a solid bottom after the osteotomy was prepped, although I did feel
a solid bottom after I extracted the tooth. I carried the implant on the driver by hand and
then advanced it a few turns using my fi ngers. As soon as I hooked on the torque wrench
I felt it drop down. I didn't use the handpiece for placing the implant, only for preparing
the site. ■
3/13/2018

BrianTolman
Member Since: 03/03/11
Post: 28 of 71

You need to get yourself a blunt-ended probe. Always probe around the bottom of your osteotomy before you place the implant, as well as probe the facial/lingual aspect of the osteotomy
to make sure that you have not perforated. ■
3/13/2018

holden
Member Since: 04/18/04
Post: 33 of 71

This happens. And a surgical guide can inhibit your "feel" for bone density and increase the
chances of overpreparing the site in a soft bone case like this.
Sometimes you can thread a long impression pin into the implant, but often it is no longer
straight up-and-down once it drops, so no dice. Rather than rooting around in there, it can be
less traumatic to just open up the hole and gently remove it from the site, rather than potentially
beating up the neurovascular bundle any more. If you were close or on the bundle, dexamethasone lavage +/- local injection can be helpful in reducing postop symptoms.
In the old days we would open these up, scratch around on the sides to make them bleed and
close them up. Now the tendency is to pack particulate graft. I wonder if the graft particles could
irritate the neurovascular bundle if they get down there. ■
3/13/2018

pjmop
Member Since: 02/15/05
Post: 40 of 71

Just wanted to second what Holden said about the guide inhibiting feedback on the density
of the bone. For this reason, I prefer a guided pilot hole and then freehand after that. You would
definitely feel the void in the bone. I call it Type 1-4, based off the Misch classification. The
cortical portion is Type 1, the cancellous Type 4. As soon as you pop through the cortical bone,
the drill drops-another good reason to use drill stops. For this type of bone, it's nice to use an
implant that can be placed supracrestal. Make a bigger hole coronal to the implant. Remove,
graft, wait. ■
3/13/2018

JUNE 2018 // dentaltown.com

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