Mini Implant Placement with Several Steps of Adjustment

When 6 and 8 mm Tomas pins are initially placed mesiobuccal (MB) and distolingual (DL) to the supraerupted tooth #2, PA is taken (Fig.1), which shows that the DL one seems too distal.  The mini implant is removed and placed more mesial (Fig.2, 7 (^: original entry)).  When the patient experiences a little pain as the DL implant is being placed deeper with minimal local anesthetic, CT is taken.  In fact the latter is between the apices of the teeth #1 and 2 (Fig.3 (L: lingual view of 3D image)).  The implant is later placed deeper with minor angular change as well as more anesthetic.  There is an advantage to place the miniimplants apically; there is more space.  But the MB implant is a little bit mesial (Fig.4).  After withdrawal, the trajectory of the implant is changed somewhat as indicated by a red arrow in Fig.5).  Note the apical placement of the minimplants (close to mucogingival junction, Fig.6,7).

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Xin Wei, DDS, PhD, MS 1st edition 07/03/2019, last revision 07/03/2019