TRANSCRIPT:

Alright, so now your alveoplasty is done and you're at the bone level that you want. Alright, so you've got a big ol' flap and you've got your alveoplasty done. And so now the next step is to find the spots where you're going to place the implants.

So, the easiest way to do this, in my opinion, is to start with the anterior tube. So there's a couple different camps on doing this. There's people that like to do the anterior tube and others that like to do the posterior tube. I think the easiest way, if you're getting started, and actually this is the way that I do it, is to start with the anterior tube.

Now the reason I like to do that is because these front ones, I know they're just going to go straight up and down. Straight up and down, and I mean, if anything, they might be angled a little bit this way just to stay in line with the bone. But these front ones, for the most part, are the straightest implants. And so it's really easy to tell what straight is, but it's really difficult to tell what 30 degrees or 15 degrees is.

So these front ones, I'm going to place straight and I'm going to place them in the lateral incisor areas unless there's a big infection in that site. So commonly for the all -on -four procedure or all -on -X procedure, there are infections somewhere, right? That's why these people are getting their teeth out. So there are infections somewhere. There are some areas that are better than others.

In a perfect world, I would place them in the lateral incisor sites. Maybe a little bit more distal, maybe in between the lateral incisor and the canine. But anywhere around here is fine. Really what you want to remember is just the best AP spread. And so I'm looking for an area around here to place my implant.

So this looks like a pretty good spot. And I'm going to start with this Lance pilot drill and I'm going to make my marking in the middle of the ridge. So let's go ahead and do that now. We're going to make our marking in the middle of the ridge and we'll go from there.

Watch. That's why I like to start with these front ones because I can look at it straight on and make sure that I'm parallel. Or not parallel, just straight up and down. So I'm just going to go straight up and down. I'm just going to sink it to that first marking right there.

Alright, so now I have one pilot drill, one pilot hole started. And I'm going to put that right there. And so now what I like to do is gently, like slowly close down the patient's jaw. See where it matches up with the opposing teeth. Let's see if I have an opposing model over here. Yep, looks like I do.

So let's say this is the patient's opposing jaw that they're getting implants up top to. So I have them slowly closed down and I see where this is lining up at and I see how it's lining up. If it's looking like that or something, then you know you're off angle. But what you want is for it to be following the long axis of the upper teeth and just looking straight. So that looks pretty straight. We can always change our angles in just a little bit. But let's go ahead and go with that one for now.

Alright, so I already marked my first implant site. That's going to be right there. Let's mark the other one. Let's place it right over here, just on the same kind of area, just on the contralateral side. So let's go ahead and mark that one next.

And so I'm going to place it kind of in the lateral incisor site, kind of like right there. Alrighty. And I'm looking at it from the front, remember? So you're going to look at it from this view right here. And it helps if you also look at it from this view. So you can ask your assistant to look at it from that view. And then you can look at it from this view too, right? But these are pretty easy. There's a platform right here. You just want to be in the middle, and you want to go straight up and down. So let's do it.

Alright, one, two, three. Alright, now you have your two pilot drills, or two pilot holes made in there. And they don't have to be exactly in the lateral sites. They're just kind of around here. And so that looks like a pretty good area to place the implants. Right here it's looking just a little bit thin, right? So I could have gotten a little bit more buckle. But anyway, let's go with that. And what I like to do is place this pilot drill back on. And let's place another pilot drill in there. Just so we can look at both of them at the same time.

Alright, we just look at that to evaluate for parallelism. This one's kind of like swimming around in there because it's not the actual pilot drill. This is just a paralleling pin. And so I'm looking at both of them. The tendency sometimes is for them to be parallel, but then offset in maybe this direction or that direction.

And so I make sure that I look at it from the side that I'm working on. But then I'll go ahead and go to the other side, and then look at it from that perspective too. I have my assistant look at it. I have everybody look at it. Just to double check. Alright, so I like how that's looking right now. And so I'm going to go ahead and take my 2mm drill and take that one to depth.

Alright, so I'm going to go ahead and put my 2mm pilot drill on here. My 2mm pilot drill. And what I like to do when I'm drilling this is I'll go ahead and leave this lance pilot drill in here. So if there's one that I like better than another, I'll put the pilot drill in that one. And the one that I like. And then the one that I don't like, I'm going to drill and I'm going to correct angle. Correct angle like right now.

Alright, so now I'm just going to take this one to depth. And let's say that I'm going to go with 11 .5mm implants. So I'm going to take this one to 11 .5mm.

Alright. So I'm going to take this one to 11 .5mm. This pin's not going to let me, so I'm just going to rotate my drill a little bit. Alright.

Now I'm at 10mm. And now I'm at 11 .5mm. Maybe a little bit deeper, which is fine.

Alright, awesome. So now I've prepped this one to depth. I'm going to put my 2mm pilot drill in there. And now I'm going to compare. They look fairly parallel. It's slightly offset, but you know, that's okay. You can correct for a little bit of angulation discrepancy with all on four. No problem at all. That looks parallel enough.

Now let's go ahead and prepare this one right here. I'm going to take this pilot drill out, put it back in my kit. And I'm going to take this 2mm twist drill again and take this one to depth. It's hard to tell what the depth is with all this bone dust on here. Let me get that off for you.

So now I'm going to put this one into the implant site as well. And now I get to evaluate both of them. So now we're at depth with both drills. We're at depth and we're happy with these implants. And these are the ones that we're going to be going with. We're not going to be changing up our angle or changing anything about it.

Alright. So that's how you start your first two implants in the front. I'll show you the next steps in just a second. But this is how you start your first two implants. And these are going to guide the rest of your whole procedure.

At this time, I'll go ahead and have the patient close down again. I want to see where they're coming out at. Because they're the mandibular arch, you obviously want to have them come out lingual to the upper arch, right? And so when they bite down, I see that it's like this. Then that means that my preparations are too far forward. And I want them to be a little bit more lingual. Because if you do it like this, let me see if you can get a side view.

So if they're coming out like that, you're going to have trouble. It might break the front of your denture. So you want them to come out the lingual. Alright? You want them to come out the lingual.

And I'm going to use these two now as a guide. So I'm going to look at them again from the front, from the side views. I'm going to ask my assistant also to take a look.

Lesson Summary

In the transcript, the speaker discusses the process of placing implants in a patient's mouth after alveoplasty. They prefer starting with the anterior two for easier placement, as the front implants tend to be straight.

The speaker looks for the best site, usually the lateral incisor areas, and marks the spots for implant placement. They demonstrate the use of a pilot drill to prepare the site and check for parallelism and alignment with opposing teeth.

• Find best site, typically lateral incisor areas
• Mark the spots for implant placement
• Use pilot drill to prepare the site
• Check for parallelism and alignment with opposing teeth

Once the position is confirmed, the speaker drills to the desired depth using a 2mm pilot drill. They repeat this process for another implant site, ensuring the implants come out lingual to the upper arch.

• Drill to desired depth using 2mm pilot drill
• Repeat for another implant site
• Ensure implants come out lingual to the upper arch

The speaker emphasizes the importance of evaluating the implant placement from different angles and suggests using these initial implants as a guide for the rest of the procedure.

• Evaluate implant placement from different angles
• Use initial implants as a guide for the rest of the procedure