A 68-year-old lady has several missing teeth (Fig.3,4 (CT 2-D images, coronal sections at the sites of #3, and 4)).  Bone density in the maxilla is low (D3,4).  Use a surgical stent for initial osteotomy (2 mm pilot drill from Bicon Cassette), paying attention to the center of the future crown, particularly mesiodistally.  Then make an incision and make sure to adjust the initial osteotomy in the middle of the buccopalatal dimension.  Use a 3 mm trephine bur for 4 mm.  Bone condensation is required: 4.5, 5 and 6x11 mm taps.  Bone graft is placed before inserting a possible 6x11 mm tissue-level implant.  Crush the autogenous graft with bone grinder and then mix with Osteogen and/or allograft.  The vertical edentulous space is high.  Long and angled abutments are expected.

Implants as RPD Abutments

Xin Wei, DDS, PhD, MS 1st edition 10/04/2015, last revision 01/19/2018