Bone Graft Where Bone Density is Low

Magic Split is used to start access (flapless) and initial bone expansion at #14.  The split does not go deep, since bone density is high in the deep portion.  A 1.6 mm drill has to be used for 13 mm (Fig.1).  Note the low bone density in the distobuccal socket (*).  Later the osteotomy extends to 15 mm (gingival level).  After 3.8 mm Magic Drill (MD) for 15 mm, a 4x11 mm dummy implant is placed with insertion torque of 60 Ncm (implant motor, Fig.2).  After 4.3 mm MD, a 4.5x11 mm IBS implant is placed with insertion torque of 60 Ncm for implant motor >40 Ncm for torque wrench (Fig.3).  The implant seems to be placed deep, but the buccal plate feels to be low.  Following bone graft buccally, especially distobuccal (Fig.4,5 ^), a 5x4(3) mm abutment is placed.  The buccal gingiva is torn during bone graft (Fig.6 >).  Periodontal dressing is applied around the abutment (for increased retention) for wound protection.

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Xin Wei, DDS, PhD, MS 1st edition 06/09/2017, last revision 06/10/2017