Guide vs. Free Hand I

After finishing osteotomy with guide, a 5x14 mm tissue-level implant tap is used without guide because of limited mouth opening.  It is not parallel to the implant at #19 (Fig.1).  A bone-level implant is barely able to be placed with guide; it is parallel to #19 implant (Fig.2).  Pre- and intra-op exam confirms periimplantitis at #19.  In addition the horizontally impacted #17 has caries.  A large incision is made for #19 debridement and bone graft. #18 bone graft (Fig.2 *) and #17 extraction and Osteogen plug (O) placement.  Postop CT shows poor trajectory of #19 implant (Fig.3 (coronal section) free hand placement), which is associated with screw loosening and periimplantitis (lingual (L) threads supracrestal).  In contrast #18 implant has good trajectory and placement level (Fig.4).

Return to Prevent Molar Periimplantitis (Protocols, Table) No Deviation
Xin Wei, DDS, PhD, MS 1st edition 02/10/2020, last revision 04/14/2020