Guided Surgery Protects Submandibular Fossa

As usual, one ampule of 2% Xylocaine with 1:100,000 Epinephrine provides profound anesthesia and hemostasis at the site of #18.  A 5x10 mm implant is placed with guided surgery in ~10 minutes.  A shortage is low stability (10 Ncm), probably due to low bone density, which is not detected early (with increasing drill diameters).  When a 5 mm tap is being used, there is basically no resistance.  In fact the tap should be not used.  When a 5.5x5 mm healing abutment is placed, hemostasis is achieved (Fig.1).  There is sufficient clearance from the Inferior Alveolar Canal (red dashed line).  More important is there is no risk of perforation of the lingual (L) plate as by design (Fig.2).  There is no reported postop pain.  There is no bone loss around the implant 3.5 months postop, which suggests that it is an atraumatic procedure (Fig.3).  The all-purpose guide also allows neutral placement of the implant buccolingually (Fig.4), as compared to the partial one.

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Xin Wei, DDS, PhD, MS 1st edition 03/26/2018, last revision 10/02/2018