Palatal Placement

Fig.1 is the buccal view of the affected teeth (#8,9) with a fistula (>) after administration of local anesthetics (including 2% Xylocaine, 1:50,000 Epinephrine).  The extraction socket at #8 is wide buccopalatal; the osteotomy will be initiated as palatal as possible (Fig.2 *), as shown in Fig.3-5 with parallel pins in place.  When a 2 mm pilot drill is being used at #8, there is sudden empty feeling; the nasal floor is most likely perforated (Fig.5 >).  When the parallel pin is removed from the osteotomy site of #8, there is moderate hemorrhage.  Hemostasis is achieved when 4.1x14 mm implants are placed (Fig.6, insertion torque >50 Ncm).  Temporary abutments (T) are placed for immediate provisionals.  The patient returns for restoration almost 10 months postop.  There is no bone loss 2 years 1 month post cementation (Fig.7).  The bony structure around the coronal part of the implants is special (*).  The gingiva looks healthy (Fig.9).

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Xin Wei, DDS, PhD, MS 1st edition 11/24/2015, last revision 02/14/2019