Do Not Change Osteotomy Decided by Stent

The 2nd stage of the upper arch implant placement consists of #5, 6, 8 and 9 (Fig.1).  The sites of osteotomy is initiated through the surgical stent with 1.2 mm initial drill.  Do not change mesiodistal position of the osteotomy, even though one or two areas are not wide buccopalatally.  Ridge split and bone expansion will be conducted.  Mesiodistal alteration may affect tooth alignment (Fig.6).

The initial depth at #5 is 6 mm, bone expander 1 at 7 mm, expanders 2, 3 at 8 mm.  Then place bone graft for sinus lift, pushed with the last expander (Fig.1,2).

Similarly, initial drill will be at 12 mm, expander 1 at 13 mm, 2,3 at 14 mm in order to elevate the sinus floor distal to the osteotomy (Fig.1,3). 

Ridge split and bone expansion is also required at #8 and 9 to push (not perforate) the Incisive Canal medially (Fig.1 *).

The palatal plate at #9 is resorbed (Fig.5 ^).  Osteotomy (Fig.6 red line) or ridge split (Fig.7) starts palatally, since the labial plate is weaker than the palatal one.  The palatally-exposed implant threads will be covered with bone graft (Fig.8 red circles) and collagen dressing or plug.

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Xin Wei, DDS, PhD, MS 1st edition 07/03/2016, last revision 07/22/2016