Flapless Surgery

The ridge at #18 is narrow.  Magic split is used for access and bone density testing as well as initial bone expansion and bending.  In fact the bone density is low.  Bone expansion is finished by Magic Expanders 3.0 mm (Fig.1) and 3.8 mm for 13 mm.  Insertion torque of a 4.5x11 mm IBS FC dummy implant is >50 Ncm (Fig.2), while that of a 4.5x11(2) mm Magicore is <30 Ncm (Fig.3,4).  To avoid reduction in torque, a tap drill should be fabricated .2 or .3 mm smaller than its corresponding implant.  The gingiva adapts to the implant well.  Therefore the flapless approach does not require suturing.  Periodontal dressing is applied for wound protection (Fig.5).  It is difficult to determine whether the coronal fins are covered by the bone.  Preop CBCT may be important to pre-determine the diameter of an implant to be placed.  The implant appears to be osteointegrated 2.5 months postop (Fig.6 (*: healing cap)).

Take BW again immediately post cementation to make sure that no cement is left behind, since the margin is subgingival.

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Xin Wei, DDS, PhD, MS 1st edition 02/13/2017, last revision 05/07/2017