Drawbacks of Free Hand Surgery

To reduce patient's expense, two implants are to be placed in narrow mesiodistal space (#30 and 31) free hand.  Time is spent to determine where to place 4 mm tissue punch.  When initial osteotomy is established (Fig.1), effort is paid to deciding whether the osteotomy is close to the Inferior Alveolar Canal (Fig.2 red dashed line).  Since the gingiva is thin (Fig.4), implants switch to bone level ones (Fig.3,4).  To have enough space between implants and the neighboring tooth, two of 3.5 mm implants are placed.  Because of the limited vertical restoration height, the implants are chosen intraoperatively to be short and placed deep (Fig.3).  Guided surgery planning can solve these pieces of dilemma beforehand. 

In fact, detailed measurements after parallel pins indicate that the osteotomy at #30 should be moved distal (Fig.5 arrow), which is consistent with post placement measurements (Fig.6).

The patient with history of bruise after minor trauma returns next day.  There is oozing from the site of #31.  Hemostasis is achieved following periodontal dressing application and 2x2 gauze pressure.  There is mild crestal bone resorption 4 months postop (Fig.7).  Because of limited vertical space, the provisionals have dislodged by the time of cementation.  It is difficult to seat the splinted crowns of #30 and 31.  Bitewing is taken after cementation: the crowns have open margin (Fig.8).  When a crown has high occlusion, X-ray should be taken prior to cementation.

Return to Lower Molar Immediate Implant, Armaments Xin Wei, DDS, PhD, MS 1st edition 04/20/2018, last revision 09/12/2018