06/08/2024
A free-hand implant placement I did for site 18. Although guided dental implant insertion provides for better accuracy and predictable prosthetic outcomes, placement using a stent may not always be possible. Most frequent limitation is insufficient space to fit the guided drills, which are longer than their free-hand counterparts, over the stent platform in posterior edentulism. In this clinical case there was insufficient space between site tooth 18 and the maxillary antagonist. Estimating proper position can be accomplished by halving mesial-distal dimension from tooth averages or using adjacent complimentary tooth anatomy measurement with a periodontal probe. Similarly a bucco-lingual dimension can be established. After flap reflection, the mid-point is market with a transfer marker such as a Thompson stick. After starter drill is used, the pilot drill is centered and angulation evaluated from all direction using adjacent teeth as landmarks. Subcrestal placement helps with controlled bone remodelling. For molar teeth large diameter implants are recommended for proper emergence profile and crestal bone stability.
