Bone quality for the 3rd implant is assessed under the raised full thickness flap. Drilling should follow the same desired RPM ang copious irrigation preferably with an NSS refrigerated the night before the surgery.
Bony defect near the site for the middle implant body
According to Dr. Sherwin Villareal – NYU, “The establishment of optimum and predictable esthetics is one of the most important and challenging aspects of rehabilitaion with dental implants.” Esthetic rehabilitation has to be predictable implying reproducibility and stability of the outcome in both short and long term. Achieving these characteristics depends on the interactions between multiple valuables namely biological, surgical, prosthetic and implant design.
Drilling procedure done on implant site.
Dental Implants which are favorable to immediate placement after extraction are as follows:
Tapered Implant
For immediate replacement after extraction, initial fixation is very important because the contact area between fixture and bone is inevitably small. Therefore, a tapered implant with has excellent initial fixation is more favorable than the straight type.
Oneplant design is favorable to GBR, photo credit: Oneplant
Implant Favorable to Bone Grafts
In case of placement after extraction, Guided Tissue/Bone Regeneration or GBR is frequently performed because of the dehiscence or space between the fixture and alveolar bone. Therefore, an implant design with a proper surface treatment for its alveolar ridge should be selected.
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Dental Implants after RTR placement and before suturing. Thorough understanding of the rationale of specific suturing techniques and materials used is important to get proper implant closure.
Dental Implants before Closure
GTR or Guided Tissue Regeneration material is placed in bony defect area. It is used to to assist in regeneration of bone tissue to maximize the potential for success of dental implant procedure.
Resorbable Tissue Replacement (RTR) placed labial to Dental Implant
It important to attain a water tight suture especially over the area with GTR or Guided Tissue/Bone Regeneration material.
Suture Technique on Dental Implant and Bony Defect with GTR
Implant closure – the mucosa was sutured in a water-tight manner.
Dental Implant Closure, third dental implant is still visible (mesial to 14)