Placed #12 implant today . Looks like I placed the implant too buccally. Should I reposition ? Implant size is 4.3x13mm . Torque-40 ncm.
Thank you!
Looks great. you don’t have much bone to work with. I would have used w/ a 3.7mm implant.
I wouldn’t remove or change now.
Thank you for your response!
Definitely don’t remove/reposition and I would suggest stop evaluating placement via CBCT because doing so will almost always show lack of buccal bone. Years ago I heard Scott Ganz lecture about how CBCT “always” underestimates buccal bone… in other words there is “always” more buccal bone present than what appears on the image. As wonderful as advanced imaging is it will never replace direct visualization. Not sure if you placed this guided and flapless but I was taught and I still believe that a person should place a minimum of 100 fixtures conventionally before they resort to AI surgery. In this situation the quality/quantity of the overlying soft tissue is more important than the thickness of the buccal bone anyway. Nice work!!!
Thank you for your reply. It had thick firm keratinized gingiva . I did not add bone graft . Patient is coming for a follow up . Implant was placed 3 days ago. Should I add a little bit of bone graft on out side of buccal plate ?
Implant was placed free hand after reflecting the flap. Also visually it looked like I had 1.5-2 mm bone . I will double check with perio probe when pt comes back
Thanks
You did have 1.5-2mm of buccal bone then because you visualized it and no you should not add graft material. CBCT is worthless for evaluating the buccal plate around a fixture and direct visualization doesn’t lie… IMHO CBCT machines are so popular in dentistry because they always justify another procedure with another expense. If that fixture has good surrounding soft tissue then it will be fine even if the CBCT image is accurate which direct visualization has already proven that it is not accurate. At the end of the day soft tissue is far more important for long term success than some radiographic simulation of white stuff that we refer to as bone.
Thank you for your explanation!