a hand driver for the implant placement so I can really feel the torque and make sure the osteotomy doesn't lead me astray. I make sure the trajectory of the implant is slightly palatal to the adjacent teeth cusps to ensure this can be screw retained. n mhd2013 Post: 9 of 71 10/12/2024 just_dentist Post: 7 of 71 10/11/2024 You need to drill to 4.2 mm or close to that. Otherwise, when you place the implant, it will more likely drift too buccal. It is a common mistake by newbies even when it's drilled to implant size. You might even need to remove more on the cervical area of the palatal bone to avoid this buccal drift. Even with full size drilling, it is not very hard to get 25 plus torque especially with a 13 mm implant. I use 10 mm for immediate implants on anteriors usually and get more than 25Ncm. Use two hands and put firm pressure towards the lingual so it doesn't drift buccal. Also, if you are thinking of a perfectly placed access hole and implant crown, your placement needs to be corrected in this way below which I aim for and do as well. I exaggerated a bit here on the photo, but don't worry about being a little close to the buccal at the apex area. The main area is the cervical area. You want your implant at least 2 mm from the buccal bone as thin buccal bone on the anterior area resorbs after losing blood supply from the PDL of the extracted tooth. Thin bone has no other blood supply than periosteum and it resorbs after exit. You seem to have fundamental ideas though and your plan is how I thought when I was a newbie. Good luck! That is a slam dunk immediate implant case once you know what you are doing. Tons of apical and palatal bone-and relatively dense bone as well. As others have said-the implants need to be a smidge deeper and can easily be angled to be screw-retained if you want it to be. In my hand this would be at least a 15 mm implant to engage even more apical bone and guarantee the best primary stability. Concepts you need to think about (and have a game plan for) prior to doing this case are: Your osteotomy needs to start in the palatal wall. What technique will you use to start the osteotomy in the right location? Your implant needs to be a minimum of 3 mm below the planned restorative margin. What is your current reference for this and is it accurate? You need to undersize the apical 1/3 of the osteotomy but make sure that the coronal 1/3 of the osteotomy is not undersized at all... this will prevent you from having the implant slide buccally during placement. How are you going to achieve this? Have you made a custom healing abutment before? What is your technique going to be to capture the correct soft tissue shape? Even though this is a great immediate case, it might not be the ideal first immediate case unless you have a really good handle on all of the above concepts. I personally think that the upper two rooted premolars are the ideal first immediate. It's usually as simple as seating the pilot in the palatal root socket, slightly refining the hole and placing the implant. n Pav Post: 19 of 71 10/13/2024 n Again, I agree with MHD. I want at least 1/3 of my implant engaging native bone. For premolars I'll normally engage as a class C socket and place a 5 mm diameter implant (this is usually a case of remove the tooth and place with no osteotomy required.) With anterior teeth I'll engage as much of the palatal bone as possible and generally online so it's common JANUARY 2025 | 15 | DENTALTOWN.COMhttp://www.DENTALTOWN.COM