[Surgery]  Anterior Immediate

Mark this question is for you. 

For immediate anterior placement I understand all of the concepts you teach I just wanted to clarify a the sequence and have a few questions.

1. Small envelope flap in the area of the immediate palatal only (if placing crown same day)

2. Use oral surgery round bur to lick palatal crest to determine where cortical and cancellous bone is

3. Next do you use a lance drill or a 557 to start 3-4 mm down the palatal wall or do you start right at the top of the socket.

4. Use 1.5 drill and go to length plus a few extra millimeters in case the implant must be placed deeper  (stent can be used to check initial angulation).

5. 2.0 drill then 2.3 drill to same depth as 1.5.

6. Deliver 3.5mm diameter ET3 implant 4mm from buccal gingiva height

1.Is there anything extra you can do to prevent the socket from leaning the implant buccal as you deliver it. I find with lateral sockets this happens pretty easily as the coronal end of the implant goes deeper into the socket.

2. Whenever finishing your osteotomy to  2.3mm diameter whether its  a single immediate or all on 6 case into existing anterior sockets will this readily accept 3.5mm and 4.0mm diameter ET3 implants.

3. The black nobel pilot drill is that 1.5 or 2.0. What was it that you liked about them specifically.




by Chad Denomme at Wed, Apr 12, 2017 7:06 PM

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Mark Kwon Replied at Wed, May 3, 2017 6:13 PM

Hi, Chad

sorry for the delay.  I didnt know about this latest post. lol

Long shank Black diamond friction grip bur for 'palatal lick'

for 3.0 fixtures, finish at 2.3 for hard bone;  finish at 2.0 for soft bone.

yes, temp crown for 3.5 system (et3) will fit on 3.0 system (et3)

- mark

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Chad Denomme Replied at Wed, Apr 19, 2017 6:13 PM

Mark do you have a favourite bur to flare the coronal portion prior to insertion

also if you go to 2.3 will the new 3.0 implant bite. Does the temp abutment mini work ok with 3.0 implant


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Chad Denomme Replied at Wed, Apr 19, 2017 6:09 PM


mark did you have a favourite bur to flare the coronal portion before insertion


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Mark Kwon Replied at Wed, Apr 12, 2017 8:01 PM

After 2.3mm drill, 'lick the palat' and proximal areas above the ostetomy to match the curvature of the insertion path to the curvature of the fixture to prevent 'buccal tilting'.

use lance drill 2mm below the height of the palatal crest  and "gently ride the palatal wall" without tilting too much bucally.

- mark