When the patient has enough bone but small interdental space, it’s hard to install the guide sleeve at the position. For #15, adjacent teeth are making a V-shape around the area. I thought that the patient has enough bone but it was too narrow to insert a fixture. I could easily insert a Ø4.0 fixture since it was premolar. This is another view of the area and I didn’t see any problem. But this is what happened when the surgical guide was designed. The sleeve was caught between the teeth. The diameter of the sleeve was bigger than space. How can you solve this problem? The answer is to set a longer offset value. But still, the sleeve again was interfered by adjacent teeth / crowns teeth.
You have to give up to use the regular sized sleeve. But I didn’t want to use the narrow sized implant But I didn’t want to use the narrow sized implant since there was enough bone for inserting regular size implant For me, Ø3.3 was mostly used for the anterior area. The only option I had was to do the design with a narrow sized implant. But I couldn’t stop thinking about the remaining bone and wonder about the possibility of inserting a regular-sized implant with a narrow sized guide. Let’s assume that I’m following the drilling protocol. At first, there will be a drill tube and start to drill with an initial drill. The next drill will be a 2.0x10mm drill. This will be the drilling path.
Without the drill tube, keep drilling with a 2.5x10mm drill. The drilling sequences have no problem so far because the guide sleeve was supporting. However, the problem appears now. If you remove the guide to use the wider drills, you’re not going to get supported by the guide and it’s easy to make the wrong drilling path. This is the ideal path but as long as you’re not making any contact with a guide sleeve, the result is unpredictable. So it’s important to keep making contact between the drill and guide. Let’s think about the other way. I found that the blade part of Ø3.2 drill can be inserted through the narrow sized sleeve. How deep it can go?
The drill can pass through like this. What I want is to use the Ø4.0 implant. Now I need to think about the length to the bottom. So far the drilling sequences have been supported by the guide. Now I remove the drill. This is the drilling path after the Ø3.2 drill is finished. I could use this drilling path as the drilling guide for the next drill. So it’s time to remove the guide and insert a 3.2×11.5mm drill. You can calculate the length by yourself. It mainly depends on the length of a fixture. At this time, you shouldn’t put too much force on drilling. You need to slowly push the drill along with the previous drilling path until the marked line reaches the gingival line /Prosmiles.
I inserted the fixture finally and it’s not so bad, isn’t it? I managed to insert the Ø4.0 implant in this narrow area. I’m showing the CBCT image and a panoramic view of the result. You sometimes encounter this kind of case. The important thing is to understand the size details of the instruments. You also need to minimize the drilling without the support from the guide.