Darin O'Bryan, D.D.S. We all have this happen to us, our schedule laid out the way we want for a productive smooth running day, then something happens to throw a wrench in it. My Wednesday morning I had a crown on #8 to start the day and then an implant right after that. The crown patient came in with the crown #5 off at the gum line.
Now we have a problem. I only have one room set up for implant surgery. I don't have time to make a guide for this case, get the tooth out and place the implant before my next patient comes in and needs her implant placed. So the decision was made to go ahead and extract and place the implant free hand. Normally implant surgery is done with a guide in my practice. There are times that either the guide doesn't fit or fabrication of the guide is not feasible. This is why it is important for doctors to have the surgical abilities to place an implant free hand.
The plan in this case was to split the roots and place the implant in the interseptal bone to get primary stability.
The roots were sectioned with a high speed hand piece with a long shank surgical bur. This serves to purposes. One is to make the removal of the roots easier. Secondly it also gives a guide for the drill to not kick buccal or lingual during preparation of the osteotomy. Now all we need to do is manage the mesial distal position during the osteotomy preparation. Having the CBCT did however help show where we needed to section the tooth and how deep to go to make sure that the tooth was sufficiently. Unfortunately due to the time constraints trying to get the case done before my next patient gets here I didn't get a photo of the sectioning. Once the osteotomy was finished the roots were removed atraumatically. The implant was then placed with 35+ncm of torque and the root areas were grafted with cortical/cancellous
Could this case have been done guided, sure but I would have either had to reappoint the patient(they are not the most reliable patient) or run behind and make my next implant patient wait. As it was the patient got the tooth extracted and the implant placed and we were on time for our next patient. Guides are great but ultimately the surgeon needs the skills to know how the surgery should go even if they don't have a guide.
