[Diagnostic / Planning]  Implant 53 retained primary.

I am removing the 53 retained primary and as you can see the ridge is pretty tight.

I want to placed a 4.0 Hiossen ETIII as I feel 3.5 may not be strong enough.

The videos shows sections from distal to mesial of the surgical area. I will be doing guided surgery.

Is the best way to approach this a ridge split? If yes can you provide details.


DO i drill 2.0, 2.3 to length and attempt placement of 4.0 and graft the buccal afterwards.



by Chad Denomme at Thu, Oct 31, 2019 11:32 AM

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Chad Denomme Replied at Tue, Nov 12, 2019 8:02 AM

Anyone know how to perform a tunnel graft?

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Chad Denomme Replied at Fri, Nov 1, 2019 5:40 AM

Mark it is 3mm and a bit at the thickest point

Can you instruct me or direct me to a video on tunnelling technique. 

Thanks Mark

coming to Toronto anytime soon?

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Mark Kwon Replied at Thu, Oct 31, 2019 1:22 PM

Dear Chad, 

good to hear from you. 

What’s the B-L width of the narrowest area mid-way? 

I agree that I would steer away from et3.5mm... you know how I feel about their likely hood of fractures. I personally would not do One-guide here due to their initial drill being too wide , you only get a one chance to make your initial drilling. I would combine this with buccal bone grafting using tunneling technique , which is more technique sensitive but will give more ideal result. Other approache is make unilateral remote incision from 14 disto buccal line angle and do the buccal veneer grafting on the 13 after you’ve placed the fixture.  My drill sequence typically would be precision, 1.5, 2.0, 2.3 then implant depending on the bone density. Hope this helps ... good luck! 

- mark , hello from Shanghai