Implantation after Implant Fracture in the Upper Jaw

Due to an implant fracture in region 14, an implant had been removed followed by a three month healing period. In this surgical video, Dr. Bolz performs the insertion of a new implant in the affected area, so that the gap can subsequently be closed with a single-tooth crown.

Following a ridge incision within the keratinized tissue, a raspatory is used to lift a mucoperiosteal   flap in the buccal direction. The preparation should be exerted as gently as possible to not traumatize the flap. In this case, the mobilization, however, is hindered as a result of existing scar tissue.
Once the flap has been prepared up to the mucogingval junction, the defect is exposed and granulation tissue has to be thoroughly removed to provide the best possible overview of the bony substructure for the implant. Initial pilot drilling is performed using a round burr, during the course of which the area is more cleaned and the exact position of the maxillary implant is determined. This is followed by the use of increasingly larger conical implant drills, the depth and orientation being checked with a depth probe.  First, the conical implant is inserted mechanically. The final implant position is achieved using a manual ratchet placing the implant shoulder in an epicrestal position with regard to the buccal bone A healing cap is attached to the implant to which both flaps are precisely adapted through suturing. Two interrupted sutures are placed from palatal to buccal to enable a precise adaptation of the buccal flap.