Combined Expansion and Drilling Osteotomy

A 44-year-old man had #9,10 extracted due to chronic periodontitis a few months earlier.  The sockets have not ossified (Fig.1).  Incision and initial osteotomy will be made with a #15 blade as palatal as possible, followed by 1, 1.5 and 2 mm osteotomes ~7 mm deep (Fig.2 arrowheads).  Next will be either bone expanders or RT 3 (for #10), 4 (for #9).  For the bone apical to the sockets, a 2 mm drill is used for 12 mm.  Insert marked parallel pins and take PA.  Change trajectory if necessary and extend the ostoeotomy until 14 mm.  Reamers will be used until 3 mm for #9 and 2.5 mm for #10.  Expected implant diameters will be 4.5 mm for #9 and 4.1 mm for #10.  By this step, the buccal plate should have been pushed buccally.  Take photos each step.

If the buccopalatal trajectory is good (implants are palatal to the future incisal edges), temporary abutments will be used.

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Xin Wei, DDS, PhD, MS 1st edition 05/24/2015, last revision 12/08/2018