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Robbie posted an update
3.5 x 13mm Immediate #7
Thin facial plate. I’m going to do my darndest to get that out atraumatically, but if, which is a high risk I’d say, that facial plate fractures, flap, membrane, graft come back in 4 months? I cant imagine membrane and grafting without a good facial wall would be indicated here.
Pro tips welcome!
Erick, Adis and Jedediah4 Comments-
Not a pro here, but I’ve done a few similar cases. Use periotomes or a thin luxator on the M/D/L and get the root loosened up, often times I’m surprised that there is more bone on the buccal than the CBCT showed. Carefully feel all the way down to the apex to check for fenestrations. If there is a thin plate, try not to flap to not disturb its blood supply. Use a round bur or Lindemann to redirect the osteotomy to the palatal native bone about 1/2 down the root.
If there is a defect on the B, you could slide a membrane inside the socket and graft the gap.
IMO most importantly don’t overpromise to the patient, say things like you’ll do what’s best depending on the situation you find which is hard to predict. Be ready to place but don’t put yourself in a corner where you have to.
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Dr. Adis has some great words of wisdom. All of those points would be very helpful. Your Digital plan looks great. I love the angulation and the overall placement other than I would definitely go slightly deeper so you are more subcrestal. Typically, I prefer my implants to be 2 to 3 mm below the crest of the bone
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2 to 3mm below the crest of the bone typically when it comes to immediate implants.
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Its fully guided, I’ll prepare the osteotomy to plan and prep a little further freehand. Appreciate the tips gentleman.
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