Bone Density and Modes of Osteotomy

After implant at #19 and RCT at #14, the 36-year-old woman has discomfort in the upper right quadrant due to caries at #4 (Fig.1 *).  After sectioning the bridge between #2 and 3, the retainer at #4 should be separated from the abutment by itself because of severe caries.  Also examine the salvageability of #2.  If the tooth #4 is nonsalvageable (Clindamycin), two implants will be placed at #3 and 4 (Fig.2-4).  Since the ridge at #3 is wide (Fig.3, coronal section (B; buccal)), use Magic Split to start osteotomy, followed by Magic Expanders.  The initial depth at #3 will be 12 mm and gradually increase to 14 mm.  On the other hand, the bone density is higher at #4, drills will be used for osteotomy.  Speed will be reduced at 50 RPM when the drills are more than 3.8 mm.  Take intraop PAs as early as possible for trajectory confirmation.

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Xin Wei, DDS, PhD, MS 1st edition 04/07/2017, last revision 01/19/2018