Initial Depth of Osteotomy

A 63-year-old man has lost the tooth #3 for long time: the first PA taken in our office is 5 years ago (Fig.1) before the tooth #5 received root canal therapy (Fig.2).  The mesiodistal space of the edentulous is narrow, 8 mm (Fig.1) as compared to 10-11 mm for normal space.

Although the bone height allows a 14 mm long implant, the initial depth of osteotomy is 10 mm.  Prepare the SM cassette.  The advantage of using 4 mm shorter drill is that it is easy to change trajectory if it is not right, determined by the 1st intraop PA.

If the bone density is found to be low while using the 2 mm pilot drill, use bone expanders until 2 sizes smaller than the final diameter (Fig.3,4).  Use the 5 mm implant positioner to preliminarily determine the diameter of the implant.  Place the initial osteotomy slightly palatal.  Check whether the osteotomy shifts buccally after each step of bone expansion or drilling.

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Xin Wei, DDS, PhD, MS 1st edition 09/13/2015, last revision 12/20/2015