IS Guides for IBS/Tatum Implants I

After finishing osteotomy with IS guide and Tatum Tapered tap 5x14 mm for 11 mm (gingival level) free hand, a 5x11 mm Tatum implant is placed at #18 with >15 Ncm (Fig.1).  Bone harvested from the site of #18 is used for #15 sinus lift (Fig.2 * as well as allograft).  By the similar fashion, osteotomy at #15 is finished according to IS drill sequence except underdrilling (4.0x7.3 mm drill with 2 O-rings).  Following use of DIO Sinus Approach Kit and placement of 2 pieces of PRF membrane and mixture of autogenous and allograft for sinus lift, a 4.5x11 mm IBS dummy implant is placed (Fig.2).  With more allograft for sinus lift, a 5x9 mm implant is inserted with >35 Ncm (Fig.3).  At #18 the implant 2.5 months postop (Fig.4) seems ok with removal of the cover screw and placement of a healing cuff.  The implant at #15 appears osteointegrated with sinus lift 2.5 months postop (Fig.5 *).  Half month later, the implant at #18 is tender associated with unipost placement.  The healing abutment returns.  A pair abutment (5.5x4(4) mm; 25 Ncm) is placed at #15. 

When the patient returns 7 months postop, BWs are taken to confirm that the abutment at #15 is fully seated, whereas that at #14 is not (Fig.6).  Osteointegration seems to occur at #18; there is no tenderness when a 4.5x3 mm abutment is placed (Fig.7).  Make provisional crowns at #15 and 18 for progressive loading.

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Xin Wei, DDS, PhD, MS 1st edition 07/18/2019, last revision 02/25/2020