Attached are pre-op and immediate post placement of a Blue Sky Bio One Stage fixture to replace #19. While I used to use One Stage/Tissue Level fixtures frequently, I like many others in the profession abandoned it in favor of a more one size fits all bone level/2 piece fixture. Now 20+ years later after seeing many of my old cases return and look great despite my lack of experience when I placed them 10+ years ago I have admitted the error of my ways and I have come full circle back to using One Stage/Tissue Level fixtures. I filled the gap of the socket with NovaBone putty so that is what is visible coronal to the original socket and I expect to to settle at the base of the polished collar so no it is not vertical augmentation only mineralized graft material coronal to the residual ridge. The purpose of this post is to demonstrate that implant fixtures do not have be submerged and treated in phases. As a bonus this system is among the easiest I have ever seen to restore and since 2008 I have had no issues with the quality of their components which I would not say about many of the other discount products out there.
Well done. 
May I ask, the insertion torque you achieved at the time of its placement.?
I set my motor to 40Ncm and it did not tap out though I would say 20-30Ncm was reached. Because it is a parallel walled fixture being inserted into a parallel osteotomy there is no wedging effect so lower insertion torque is normal when placing parallel fixtures. I am not so sure that the lower initial insertion torque coupled with the one piece transmucosal tissue level design aren’t both critical factors in the long term success of this design. At any rate if you decide to place parallel walled fixtures be prepared to place with less initial torque but don’t worry as this product will show you that this number is of little value in predicting future success.
I was wondering about the initial torque in the context of primary stability, as this implant was placed in an extraction site rather than a pristine bone or healed site.
Scotty. 20 and 18 doesn’t look too hot. 18 mesial looks like very deep pocket.
Question. Does this tissue lvl blue sky bio system use a different surgical kit than blue sky bio max? I’ve only used blue sky bio max for far.
You are correct about the radiographic appearance of #18 and #20. Fortunately despite the significant bone loss as seen on the x-ray both have healthy attached soft tissue and no bleeding on probing or probing depths greater than 2mm so he is what I would call a stable individual with a history of periodontal disease. If #18 and #20 were not in the radiographic condition that they are then I have no doubt that the Veterans Administration would have placed a 3 unit bridge rather than refer him to me for implant placement. As far as BSB One Stage being compatible with the Bio Max kit I think the answer is sort of… One stage uses parallel osteotomy drills in the sequence of 2.2mm-2.8mm-3.5mm-4.3mm while Bio Max utilizes a 2.6 in place of the 2.8, as far as I can tell from reviewing the contents of the kit online. I know One Stage has a unique driver/insertion tool as well. While I doubt it would be recommended I think you could get by with purchasing a driver and using your existing kit just be aware that the 3.3mm diameter One Stage is designed to be inserted into a 2.8mm osteotomy.
When placing parallel wall implants I have found consistently lower primary stability/insertion torque compared to what I typically achieve with tapered bone level fixtures. Regardless of the nature of the case , immediate placement vs. delayed, I have found that initial insertion torque in the range of 20Ncm is normal and despite this reduced “primary stability” they are still done one stage with a higher success rate. It is my experience with this system that has convinced me that insertion torque/primary stability is only as important as we let ourselves believe it is and in the absence of immediate load I believe it is of little or no real value. After placing hundreds of these fixtures with what many would consider inadequate primary stability and allowing them to heal in a One Stage manner I am amazed at how significant a 12 week osseointegration period is. While I can’t prove it in the form of a “scientific study” my experience has shown me that initial primary stability is only a number and has very little to do with success in conventionally loaded implant fixtures.