hello and welcome to chairside live I'm your host Megan strong and I'm so glad you're tuning
in today what a great show we have lined up and are you still entertaining the idea of
placing implants come on now's the time doctor by May just give you the pushing need to get
started he's beginning with the basics and showing us another straightforward implant
case this basic implant case on tooth number 30 dr. Bai is taking us through his protocol
for placing the implant and demonstrating how important case selection is when you decide to
start placing implants we hope to provide the clinical education to encourage you to
jump into this exciting and rewarding aspect of Dentistry get ready because it all starts now
hi there I want to welcome everybody back for another case of the week here on chairside
live and I want to present this case to the practitioners again that want to incorporate
implant dentistry into their practice obviously I've done this in the past were presented cases
were that are ideal in this situation the patient is missing tooth number 30 so I bring the patient
in initially for a consultation and examination obviously I want to use my radiographs and a cone
beam CT scan to take measurements so that I know what size implant I want to place in this area the
CT scans are very accessible pretty much everyone in private practice and it's a good tool to have
so after the diagnosis and treatment planning I'll bring the patient back the following visit
and we'll go ahead and start the treatment and what I usually like to do is reflect the full
thickness flap the flap design is really based on where you have your mica gingival junction
and the keratinized tissue on the buccal of the tooth or the area that you're placing the implant
and you could design it so that you can create a little bit more care nice tissue with the
healing if you need to in this situation it was a straight forward flap design crystal incision and
I can go ahead and access the bone and I want to create a flap that's big enough that I can
actually visualize not just the top of the bone or the occlusal surface area but also buccal e
and and a little bit of the lingual as well so that I know where my undercuts are and I can
go ahead and create my osteotomy so the flap is reflected and I'll go ahead and remove any
residual soft tissue and then I'll start with my start drill now usually what I'd like to do
is create that initial osteotomy with the start drill and then take the parallel pin and place
it into the osteotomy site and take a radiograph this will kind of help me gauge the direction of
this implant and whether I'm going in the right direction or not both visually I can look at it
and say you know this parallel pin is coming out exactly where I want my screw access hole
if I'm placing a screw routine final restoration if it's not then I can make adjustments with every
subsequent drill that I'm going to be using moving forward so in this case I move the next osteotomy
drill and then I follow that up with the shaping drill which you see here it's important to use
irrigation when you're using the shaping drills so that you don't cause any necrosis of the bone the
RPM I use is between 800 to 1200 rpm and I'll go slowly and create my osteotomy in order for
the area to receive the implant now what I do is as I move up in size with the shaping drills
I want to use my parallel pen again to make sure that I'm going in the right direction as you can
see here I'm not so now I have a chance with the next shaping drill to up right in the area
and make sure that I can place the implant in the proper position so now I can lean my
shaping drill to the direction where I want to create that osteotomy and this technique gives
me a chance to place the implant in the proper position so once I'm confident that I've created
the osteotomy and it's in the right direction then I can move forward and place my implant so
there you have a view of where the osteotomy is and I'll go ahead and load the implant with the
implant driver onto the torque wrench and I'll place that directly into the osteotomy site and
I'll start to thread the implant into the bone so very straightforward procedure you can also
do this with the handpiece and the handpiece has to be turned down to 25 to 35 rpm so that you're
placing the implants slowly and I feel confident with the torque wrench in this situation and
that's what I used and this implant is bone level implants those designed to be placed
at the level of the bone sometimes on the lingual the bone level might be a little bit higher than
the buccal and that'll show on the radiograph I elected to do a one-stage procedure where I want
to use a healing abutment and not a cover screw so healing abutment goes through the tissue the
tissue heals around it and you don't have to come back and uncover the implant and once the
cover screw is on there I'll go ahead and place a couple of interrupted sutures in this situation I
used again a chromic suture and as you can see here and approximately I had plenty of space
to have the implant from the proper position and with the final radiograph you can see that I was
able to further upright that implant and place it in proper position for the final restoration
so another case where if you're incorporating implant dentistry into your practice this case
would be ideal because there's plenty of bone and approximately means you distally buccal lingual
II and also the nerve is far enough away from the apex of the roots and the implant where I can feel
confident that I can place that implant without hurting the patient so thank you for joining me
for another case of the week and hope to see you back here in the near future thank you for
that doctor bye and we hope you'll stick around for even more implant cases on upcoming episodes
well that about wraps it up for this episode of chairside live on behalf of everyone here
at glial laboratories thank you for watching and I'll meet you right back here next time
you