hi everyone and welcome back to another case
of the week I want to share this case with you and if you're incorporating implant dentistry
into your dental practice cases like this would be ideal to start out with and repetition with
cases like this will lead you to expanding your knowledge base and your comfort level you can
expand what you're doing within your practice so for this case the patient presented with plenty
of interproximal space plenty of bone so that we can do the proper diagnosis and move forward with
the implant placement so the first visit a patient comes in and we evaluate periodontal status
obviously the caries and make the diagnosis and and provide some treatment for the patient
and the patient it has to be periodontal e sound for us to move forward with implant dentistry
also I go through a series of evaluation of the radiographs and the cone beam CT scan so that I
know how much bone I have and I can go ahead and place the implant in the proper position so once
I have the diagnosis down I bring the patient back and provide some anesthetic with local
infiltration and once the patient is nice and comfortable with the anesthetic I can go ahead and
provide a full thickness flap reflection so that I can access the bone in this scenario I do a full
thickness flap I reflect a full thickness flap and I want to make sure that I have the access to
the cortical plate of the bone but once I reflect the flap I'll go through and remove any residual
soft tissue I want to make sure that I have full access to the bone as you can see here so step
one have access and be able to visualize where I want to place the implant and step two is to go
ahead and create my initial osteotomy with the start drill the start drill basically allows me
to follow up with additional drills in order to deepen and widen my osteotomy so that I can place
the implant what's really important for me is when I'm placing the implant I want to go ahead and
check with a parallel pen to make sure that my osteotomy is in the right direction as you can
see here I might be tilted a little bit to the distal or the mesial and one way to really confirm
that is to take a radiograph to make sure that I'm away from the vital structures and I'm not tilted
in the direction that I don't want to be tilted in after the first start drill I'll go ahead and
move to the second start drill before going into the shaping drills another shaping drills for
the Hahn implant system are designed so that the shape of the shaping drill is the shape of
the implant and you don't have to worry about depth because it's built into the shape of the
drill you just place the drill to the bone and you can predict how deep it is by where you place
the drill into the osteotomy and again I want to use my parallel pins usually at the next step in
order to see whether I'm in the right direction and whether I need to change the angulation it's
really important to move up in the drill sizes and give yourself a chance to correct the angulation
if you are off angled so that's something to keep in mind and it's a very systematic process you
don't just go from the start drill to the final shaping drill you want to move up in width and
length of the drill so that you know you have a chance to correct angulation if you run into any
trouble so moving up to different drill sizes I get to the final drill and in this situation it
is a 4.3 by 11 1/2 millimeter diameter implant so my final shaping drill is going to match the
shape of my implant once I finished osteotomy with the final shaping drill I'll go ahead and
place the implant you have the option of placing the implant with the torque wrench or you can
use the the surgical handpiece but you don't want to use the same rpm as you're creating the
osteotomy so you'll want to drop the RPM down to 25 to 30 so that you have a lot more control with
placing the implant once the implants in place you can place a cover screw or a healing about
man and in this situation I wanted to place a healing abutment that goes through the tissue the
tissue heals around it after i suture everything and then I can come back if when I want to take
the final impression I can come back and remove the healing abutment and place my impression
coping and take the final also once I finished the procedure and place the implant it's fairly
simple to place two interrupted sutures in this situation we use two interrupted chromic suture x'
the tissue was approximated fairly well and as you can see here the implant is in place and now the
patient goes through a period of osseointegration before I bring the patient back for the final
impression I want to thank you for your time and I hope you enjoyed the case of the week and if
you're incorporating implant dentistry into your private practice cases like this would be ideal
and build your skill level and your confidence you
