Trephine Bur for Osteotomy

A 49-year-old lady has lost #2-4 for quite a while (Fig.1, no indication for antibiotic study (for cases with <6 months post extraction)).  Bone height at #2 and 3 is limited.  Use a 2 mm pilot drill to start osteotomy with rubber stopper at 4 mm, followed by insertion of 2 short parallel pins (PP)  at #2 and 3 (Fig.2,4,6,8). The PPs may be not stable because of shortness.  At #4 (8 mm initially), insert a marked PP for PA.  If the position and trajectory of each osteotomy is correct, use trephine burs for further osteotomy at #2,3, since they have labels of 2,4,6 mm.  For example small one at 4 mm, larger one at 6 mm.  If the bone stays in place after trephine bur usage, use Bicon osteotomes to do sinus lift.  Allograft and Osteogen is to be loaded in small syringes (x4).  Previous implant surgeries indicate that the bone density of the maxilla is high (1,2).  CT shows variable density (compare Fig.1 vs. 2, 3 vs. 4 et al).  The density at the medulla is low; that at the cortices high.  The patient plans to have 2 implants.  If the implant at #3 is not stable, the implant at #2 will be needed for splinting.

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Xin Wei, DDS, PhD, MS 1st edition 08/20/2015, last revision 08/24/2015