even small errors would cause the
provisional to bind. (A more effec-
tive method of provisionalization is
discussed in Cases 2 and 3.)
the residual root was sectioned in
quarters (not in half) and removed
layer by layer(Fig3). Care was taken
not to injure the buccal or lingual
plates of bone. A periotome was not
used. The use of a Woodson elevator
is recommended for this extraction.
After complete removal and inspec-
tion of the socket, a 2-mm round
bur was used to create a pilot slot
so that the subsequent drills would
pass lingual to the apex of the tooth.
This is an important step needed to
ensure that the apex of the long im-
plant does not perforate the buccal
plate. Also, the cervical portion of
the implant will emerge against the
facial gingival tissue to provide sup-
port. As the socket is oval and the
implant is round,placement of the
implant facially will be stmimic the
facial emergence profile of the origi-
nal tooth.
initial round bur. A guide stent was
utilized to show the emergence of
this osteotomy. This should always
be checked during the procedure
(Fig 4). Next, a 3.5-mm internally
cooled contra-drill was placed into
the 2-mm osteotomy. The length
utilized should be approximately 3
mm above the apex of the post-ex-
traction socket.The top of the drill
should be approximately 2.5 mm
below the facial soft tissue height.
The final drill used was 4.3 mm.
The hole made by this drill should
be very precise; it should not be any
deeper than the planned placement
of the implant. Over contouring of
this hole will cause the implant to
be mobile.
into the site and the tooth form
implant was screwed into place. Re-
gardless of implant size, there will
be some gaps between the implant
and the post-extraction socket. Uti-
lization of platelet-rich plasma will
create a bone clot to fill this space.
coated surface of the implant was
giva and verified with aperioprobe.
The laboratory-fabricated provision-
al was placed after relieving the inter-
proximal areas to prevent binding.
A laboratory-fabricated provisional
is technique-sensitive due to the dif-
ficulty in predicting the rotational
alignment of the Nobel Perfect im-
plant fixture (A preferred method
of provisonalization is discussed in
the next two cases.) The shade of
the provisional was modified by ve-
neering it with composite (Renamel,
Cosmedent;Chicago,IL) to decrease
the value and increase the surface
polish. The cervical area was formed
using a brass analog. After cemen-
tation with a small ring of provi-
sional cement (Temp Bond, Kerr;
Orange, CA), the restoration was
taken out of occlusion in centric and
all excursions.
crown in place over the next three
months. Tissue contours weree valu-
ated and it was decided to proceed
with the case. After removal of the
provisional, a full-arch impression
was taken with transfer coping in