TRANSCRIPT:

Okay, so now I want to show you my basic technique for anterior implant placement. So what I’m going to be doing is starting with this little pilot drill after I flapped the site of interest. Right after I flapped it, you want to find the midpoint – mesial distally and the midpoint buccally, facially, lingually. Right? Here's about the midpoint right here.

Now before I start drilling, I'm going to make sure I'm not too far this way, not too far this way. The way that I kind of approximate that is I look at an x-ray because sometimes the coronal portion of these teeth might look one way, but the root's like going this way or something, or maybe the root's going this way. So by looking at an x-ray I can see which way I have more room sometimes.

You don't have too much room in these anterior implants so I'm going to go ahead and start drilling right here. And so I'm actually showing you this surgery with a new little handpiece, got LED illumination. To see the pricing details and special discounts you get on it, go to the last section, it says what to buy. So, I really love this thing. It's really nice drilling with LED lamination.

Anyway, I'm taking it to that first line that you see there on the locator, on the pilot drill sorry. I'm going to go up and down like that. One thing to note is that when I'm drilling these anterior teeth, sometimes they're angled maybe like 15 degrees, facially. The incisal edges flare out like 15 degrees, right? So, I would say that's like a 15° angulation.

What I like to do is try to angle my drill, instead of angling my drill this way – this is just a little bit exaggerated – instead of angling my drill this way, I try to straighten it up a little bit. Now the reason I do that is because I don't want my access hole to be too far facially. I know you can use a cement retaining crown to try to correct that but sometimes it's a little harder than it might sound, sometimes a little bit harder to correct the angle because your access hole might be coming right at the cervical portion and might be a little bulky right there.

So anyway, rather than angling it too far this way, I try to stand it up a little bit, maybe at 15 degrees or less so that it comes out, the access hole comes out by the singulum area. It’ll be really nice. The trouble with doing that, so if I'm standing up, as I rotate it this way – what's going to happen to the tip of this drill? Right? I might fenestrate right here. I might perforate through the bone right there.

So you have to balance between the two things, balance between being too facial and balance between perforating through that, through the bone right up here. So that's where you kind of have to have a balance. Anyways, I'm drilling right in this area like that, can kind of note my angle. You already saw me drill it from this view and so I'm already at that first marker. So now I'm what I’m going to do is I'm going to take off this little pilot drill and I'm going to stick it right in there. Just like we did with the other cases. And then I’m just going to look at it. I'm going to have my assistant look at it too. If it looks like I'm pretty straight, it looks like I am pretty straight.

I might be slightly angled towards this root a little bit but now is a perfect time for an x-ray because an x-ray is going to tell me if I'm too close to this root right here. Or it might tell me that I can actually just continue the path where I'm at and just go deeper and so just by drilling to this first line right here, I'm really minimizing my risk of perforating adjacent roots or drilling somewhere where I really don't want to be. So aside from looking at it from this, you can look at it from this view and honestly right now, this looks to be too facial.

I would like to be a little bit more straight up, right? Not like that. I want to be like that. So, that's something it's still correctable at this phase because I haven't drilled too deep. So, go ahead and take an x-ray now. And then we'll continue.

Okay, so now I remember how this was angled too facially. So what I'm going to do with my next drill is actually just straighten this up a little bit. I don’t want to straighten up too much. I think maybe just correcting it like 5° or something. Something real minimal like that will give us a better result. So, I'm going to switch out to my other drill and for this case that I’m showing you I'm actually drilling using the Implant Direct kit. If I had the other kit, the Zimmer kit, I would just correct this angulation with the Lindemann drill, but the Lindemann drill doesn't come with this kit. So you might want to pick that up separately.

So anyway, remember we're right here at that angle. I'm just going to straighten it up a little bit. Not too much. I don’t want to be like that either. This is my original angulation, I’m just going to stand it up like that. And I'm going to drill.

Alrighty. Just going to blow off some of the sawdust. Okay. So now my angulation is corrected a little bit, I'm going to take this guy off and check it again. Definitely never feel bad about checking and rechecking, you just want this thing to be spot-on. I like this better. I like that angle way better.

So now you just going to take it to depth. If you're nervous about it, you can take another x-ray at this point right here, but otherwise, you just continue drill to the desired depth. So I'm going to go ahead and just take this a little bit further. And you'll make sure you could follow the same angle, it's easy to accidentally change angles, so don't do that.

I kind of go up and down. Alright. Blow off sawdust again. Alright, so there’s my implant preparation. Put this guy back on and now it's just the same sequence. As any other tooth, I just wanted to show you that we have to be careful about that angulation. So I hope that was helpful for you and in evaluating and what you should be drilling at for anterior cases.

One final little note about something that's a little bit different. With these cases with anterior, #8 and #9 cases, especially, is that the vital structures you want to avoid obviously are these adjacent but there's also one more factor. There's the nasal-palatine Canal right here and so you do want to be careful to avoid placing your implant too close to it. And compressing, the nerves that lie within it. In some very rare cases, you can actually graft the nasal-palatine foramen, you can even graft the canal and push the nerve inside further superiorly, but it's definitely not something that you want to attempt. If you are new to implants and you're just getting started. That's a pretty Advanced thing to do.

And so, if you want to find out more about it, there's a little section in that in the anatomy section. Actually, you should have seen it about implants and the nasal-palatine Canal. But yeah, just take note, if a tooth been missing here for a while, the canal tends to enlarge. And so it's more likely to be in your way so definitely check it out. Make sure you're aware of that. And so that way you can place your implants here safely.

Lesson Summary

In the dental field, the process of drilling and preparing for implant placement in the anterior region of the mouth is explored.

The author stresses the significance of angulation and balance during the drilling process to avoid puncturing through the bone or positioning the implant too facially.

Emphasis is placed on the use of x-rays to evaluate the placement and to make adjustments to the angulation if necessary.

Special care should be taken to avoid placing the implant too close to the nasal-palatine canal, as this can cause damage to the nerves located within.

The basic technique for anterior implant placement is explained in detail.

• The midpoint of the implant site should be identified to ensure optimal drilling direction, with reference to an x-ray.
• Proper angling of the drill is of utmost importance to prevent complications
• A drill with LED illumination is recommended for better visibility during the procedure.
• The steps of drilling are described, with a reminder to adjust the angulation as needed.
• The nasal-palatine canal is highlighted as a vital structure to be cautious of and avoid during placement.