Limited Bucco-Lingual bone availability and limited Mesio-Distal space between teeth

Categories ; Posterior, grafting, Nobel Biocare

Narrow space, limited bone availability , angled abutment, no bone grafting, soft tissue grafting implant will be used as orthodontic anchorage

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Limited BL bone volume

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Place the implant where the bone is, so need for angled abutment. Alternative was extensive buccal bone grafting.

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An angled abutment will be needed

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ND barely fits in this MD narrow space

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Reversible connection of RIR to vacuform, allowing verification of position before permanent fixation with ortho acrylic

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Permanent connection with Ortho Acrylic

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Cut and remove cross bar

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Retention rails exposed

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Green = 0 degree rotational correction from model determined axis Yellow = 3 degree rotational correction from model determined axis Red = 7 degree rotational correction from model determined axis

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Green = 0 degree rotational correction from model determined axis Yellow = 3 degree rotational correction from model determined axis Red = 7 degree rotational correction from model determined axis

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Green = 0 degree rotational correction from model determined axis Yellow = 3 degree rotational correction from model determined axis Red = 7 degree rotational correction from model determined axis

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Note restricted space for guided surgery. Because rotation block is monolithic it has minimal additional mesio- distal width. Specifically compared to metal guide sleeves which need circumferential material to hold them in place. .

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In – correct X-ray angle. RIR’s do not overlap. Retake radiograph.

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RIRâ&#x20AC;&#x2122;s do overlap; image is diagnostic. 3 degree rotation block is selected

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Drill guide placed in rotation block to indicate level of rotation

RIRâ&#x20AC;&#x2122;s do overlap; image is diagnostic. 3 degree rotation block is selected

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Mini flap.

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Tunnel for Connective Tissue grafting

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2.0 mm twist drill, with red 3 mm Flexistop. 13-3 = 10 mm implant

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Osteotomy prepared for 10 mm implant

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Note that twist drill is rotated 3 degrees, with the yellow rotation block, compared to RIRâ&#x20AC;&#x2122;s

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2.8 mm

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Additional 3 MM Flexistop added for step back preparation of last drill. Nobel Active is tapered implant.

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Guided tap

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Final osteotomy

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Guided Implant Placement

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Guided Bone Mill

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Healing Cap

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Tuberosity connective tissue graft

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Connective tissue graft

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Guided and delivered as planned

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Buccal contour enhanced

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