Preparation for Tissue Punch and Trephine Bur
Place an implant positioner over the ridge (4 or 6 mm) to determine whether there is enough keratinized gingiva buccally and lingually.
Once a tissue punch is finished, a curette is used to remove the tissue or push it buccally. Pass a 3/4 mm (inner and outer diameter) trephine. Depth is ~ 6 mm from the gingival margin. Either push the bone apically gently and slowly using 4 mm Bicon concave-end osteotome (if the bone is loose) or use Tatum pointed osteotomes (otherwise). If the sinus membrane is perforated, use a piece of Collagen Dressing large enough to cover sinus dome (*) so that bone granules will not move freely. DIO large diameter implants are as short as 6 mm with threads to achieve primary stability. The shortest Tatum implant is 11 mm (9 mm in bone). Bicon implants are short, but they do not have threads to achieve primary stability. If the latter is high, prepare (possibly DIO) abutment for an immediate provisional. The tooth #13 is mobile and needs stabilization.
Xin Wei, DDS, PhD, MS 1st edition 11/30/2014, last revision 11/30/2014