Free Hand Delayed Implant of Upper 1st Molar with Narrow Mesiodistal Space, Dental Education Lecture, Duluth (Atlanta), Georgia, USA

Eight-month limited ortho including use of a 1-piece implant (Fig.3 P (ball type)) as a distal anchor increases the mesiodistal space of #14 from <4 mm to 6 mm (near premolar width). Guided surgery is not indicated because of presence of brackets and band and the narrow space. Also due to the latter, incision is difficult to make. In stead a 3.5 mm tissue punch is applied. After 2.2 mm drill, a parallel pin is placed; it appears that the initial osteotomy is palatal (Fig.1). Lindamann bur is adopted to move the osteotomy buccal. The last drill (3 mm for 3.5 mm implant) has no resistance when it enters the buccalized osteotomy. A longer implant than designed is placed (3.5x13 mm, Fig.2,3, close to the sinus floor (dashed yellow line) with 50 Ncm. When the implant osteointegrates, it will be used a mesial anchor to distalize the 2nd molar.

I've looked into the CT and it seems like narrow implant would work with 12mm offset (Fig.4). And also it appears to be less than 5.5mm between teeth so I had to raise the level of offset to the max. Jennifer
While the implant is being osteointegrated, the edentulous space increases from 5.5 mm to 7.39 mm using the distal anchor implant in 3 months (Fig.5). The patient is able to masticate normally 1 year 8 months post cementation (Fig.6). The mesiodistal width of the crown is 7.9 mm. There is no bone loss 23 months post cementation (Fig.7).