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Categories ; Anterior, Flapless, Grafting, Multiple implants, Immediate

placement, Nobel Biocare

Courtesy of : Aparna Subramanian, prosthodontist San Francisco, CA

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Active infection # 10, Incisive foramen of significance

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BLP set for screw retained crown

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BLP for screw retained crown. 2 mm buccal resorbtion anticipated, note line

drawn 2 mm from current buccal contour

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Regular Diameter for # 9, Narrow Diameter for # 10

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Wings are fitting well without crowding. In certain cases it might be needed to

make two distinct individual surgical guides, i.o, one.

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Note that implants are not in line, but positions are dictated by the desired

prosthetic outcome

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Removal of root and debridement of socket

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Harvesting of “ free “ connective tissue

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Radiograph is diagnostic for # 9 site, note foramen. A 3 degree rotation block is

selected to clear foramen

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# 10 radiograph is diagnostic, set up is accepted

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2 mm twist drill at 10 mm, the decision is made to increase the rotation to 7

degree, with a red rotation-block to increase the safety margin with the foramen

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Nobel Active 4.3 x 10 MM is placed

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The “ free “ connective tissue is grafted to augment the buccal

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2 mm twist drill

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The decision is made to rotate 3 degrees with a yellow rotation-block

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Guided tap

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Nobel Active 3.5 x 10 in the # 10 site @ 50 N/ cm , Note that # 9 has a similar

inclination as the natural root of # 8, clearing the incisive foramen

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Osteotomy # 10

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Alveolus # 10

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Implant # 9

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Grafting with minimally resorbable Bio-Oss, aiming to maintain maximal buccal

contour

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Collaplug + cyano acrylate tissue glue

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One week post operative