Place Mini-Implant Apical to Mucogingival Junction
The first two times of mini-implant placement is done without incision or pilot drill. The third time, a vertical incision is made between the teeth #27 and 28 after minimal buccal injection. A pilot drill is placed just coronal to the mucogingival junction (MGJ). It quickly become unstable. An exploration shows that the lingual half of the bone is soft and tender, probably entering the previous osteotomy. Therefore the pilot drill has to be moved slighly apical to MGJ. After penetration of the buccal cortex by the drill, a 1.6x6 mm mini-implant is placed initially (Fig.1). Then the trajectory is changed away from the tooth #28, while the implant is placed deeper. There is great resistance before the implant is fully placed (Fig.2). The patient feels mild discomfort lingually, but there is no sign of lingual plate penetration. Postop, the contact between #28 and 29 is tightened. Cross arch retraction starts immediately.
Forty-eight hours postop, the tooth #6 needs occlusal reduction to alleviate discomfort in association with premature contact.
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Xin Wei, DDS, PhD, MS 1st edition 04/05/2015, last revision 04/05/2015