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