Dentaltown May 2021 - 47

beyond the buccal and lingual plates. This
will allow you to get a small elevator into
the trough and elevate against bone only,
without inadvertently putting pressure on
other teeth. The aforementioned conical
nature is favorable to elevating forces. Refer
to the cone-beam section pictured earlier
and you can see why within 10 seconds,
this particular tooth was out of the socket
(Fig. 5). Bone removed without damaging
the buccal and lingual plate will simply fill
in with the natural healing process without
compromising the vertical dimension, and in
the case of immediate implant will be aided
by the bone graft material used.6

Chart 1

Anesthesia

Fig. 3a

Initiate
surgery
(i.e. extract
tooth)

Blood draw
& spin

Fig. 3b

Prepare
membranes,
grafts etc.

Complete
surgery
(grafting,
implants etc)

Fig. 3c

Placing the implant
The implant placement at this point,
given the aforementioned favorabilities, is
easy. You will start your osteotomy with
the drill laterally pressed against the lingual
plate within the socket (Fig. 6). This will
keep your implant positioned centrally
within the alveolar process apically and as
far as allowable from the thin buccal plate
crestally, to allow for allograft to be placed
in that subsequent gap.
I recommend underpreparing the osteotomy by one size to ensure that primary
stability is achieved. Because only the
apical third or so of the implant will be
engaging the bone, you can avoid having
your planned implant size freely spinning
with no retention.
If you're not placing an immediate
provisional or healing collar, you want to
achieve at least 20Ncm of torque, but more
will ensure that the implant will stay stable
even only with that apical engagement. As
you are packing the allograft and potentially
putting forces on the implant, you do not
want it easily displaced.
If you will be placing a provisional or a
healing collar, aim for 35-50Ncm. Over the
first few weeks, as the bone is remodeling,
there will be a loss of up to 60% of the
implant mechanical stability, so a low
initial torque could lead to early failure
due to micromovement from masticatory
forces.7,8 We want to make sure that in this
period there is enough residual retention
left to withstand these forces until the bone
remodels to a stronger biologic connection
to the implant.

Fig. 4a

Fig. 4b

Fig. 5

Fig. 6

Earn CE credit and learn about
immediate anterior implants
Dr. LeRoy Horton's CE course takes readers through a step-by-step process
of performing an immediate implant placement in the anterior maxilla, with
discussion of principles that will aid in surgical, restorative and aesthetic
success. To get started, go to dentaltown.com/horton-ce.

dentaltown.com \\ MAY 2021

DT0521_Horton_Implants-MM.indd 47

47

4/19/21 10:30 AM



http://www.dentaltown.com/horton-ce http://www.dentaltown.com

Dentaltown May 2021

Table of Contents for the Digital Edition of Dentaltown May 2021

Dentaltown May 2021 - Intro
Dentaltown May 2021 - Cover1
Dentaltown May 2021 - Cover2
Dentaltown May 2021 - 1
Dentaltown May 2021 - 2
Dentaltown May 2021 - 3
Dentaltown May 2021 - 4
Dentaltown May 2021 - 5
Dentaltown May 2021 - 6
Dentaltown May 2021 - 7
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Dentaltown May 2021 - 24
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Dentaltown May 2021 - 62
Dentaltown May 2021 - 63
Dentaltown May 2021 - 64
Dentaltown May 2021 - Cover3
Dentaltown May 2021 - Cover4
Dentaltown May 2021 - Outsert_SI1
Dentaltown May 2021 - Outsert_SI2
Dentaltown May 2021 - Covertip_SM1
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Dentaltown May 2021 - Covertip_SM3
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