The surgical guide fits well without #9 distal trimming.  With 34 mg Xylocaine and 17 mcg Epinephrine infiltration at #10 and 12, the patient feels pain when 2.2 (in fact 1.9) x8.5 mm drill is being used.  When Septocaine is added, the osteotomy at #10 is found distal.  Out of curiosity, PA is taken with 2.2x10 mm drill in place; its trajectory seems satisfactory (Fig.3).  When a 2.5x13 mm 1-piece implant is placed free hand, it deviates palatal, which is confirmed with incision after addition of 34 mg Xylocaine and 34 mcg Epinephrine.  A new osteotomy is created by S-Mini Kit buccal to the previous one.  With Lindamann bur to adjust the position of the new osteotomy twice, the last drill (2.0 mm) apparently starts to perforate the apical portion of the buccal plate.  The perforation seems to enlarge when the mini implant is re-placed (Fig.4 <30 Ncm).  With Vanilla graft (Fig.8 pink circles) and abutment height adjustment (Fig.4; original height 10 mm (cuff: 2 mm)), a provisional is fabricated with occlusal clearance.

From Guide to Free-hand Last Next

Xin Wei, DDS, PhD, MS 1st edition 09/24/2018, last revision 09/24/2018