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PA taken with a 1.2 mm drill for 14 mm shows a horizontally impacted canine (Fig.4: #6). When the osteotomy is finished without apparently buccal perforation (Fig.5), the trajectory is buccal. When a 3x14 mm (12.5 mm in bone) 15 degree angled 1-piece implant is placed with normal trajectory (Fig.6), the buccal plate is perforated. As the implant is redirected so that the apical end of the implant does not stick out buccally, the trajectory returns buccal (Fig.7). The buccal aspect of the abutment is heavily reduced for an immediate provisional. The perforation is repaired with Vanilla Graft and Collagen Dressing before suturing. CT should have been taken preoperatively; the osteotomy should have been initiated as palatal as possible, as compared to that in Fig.5. The implant is stable nearly 4.5 months postop (Fig.9).
Xin Wei, DDS, PhD, MS 1st edition 01/12/2018, last revision 07/05/2018