Implant parallel to adjacent tooth: how to remedy?

make a quick surgical guide on a cast to guide the drills. The Guide-Right system is easy to use for this. The tendency is to tip a drill mesially when drilling in the posterior

It sounds like you might be using to much of your wrist when drilling the osteotomy. We tend to use a purchase point when we are drilling, based on years of restorative but when you do the same technique during an Osteotomy your handpiece will tend to follow and arc rather than remain parallel. this might explain why you are getting the mesioangular orientation although its hard to say without seeing how you are performing your surgery. You might want to do a couple of surgeries with a mentor just to see if there are some small corrections you can make to your technique.

Use a surgical guide to start and check the angle with a guide pin on the radiograph. Placing an implant is in three planes like orthognathic surgery not like restorative dentistry. It is very easy to get disoriented. Check all three planes, sagital, coronal and axial. Not as easy as it looks. Have an assisiatant stand at the patients feet, you are on one side and your chairside assistant is opposite you. Drill all the pilots first to line them up parallel, then increase the diameters.

I used to make all my own surgical guides and then I had them made by companies such as "Anatomage". There is not always enough room for the guide and the drill. I saw the "MD Guide" advertised on this site and bought it. I use it for almost all of my cases. Parallelism is simple with the guide. I highly recommend it.

Hi, the medio angulation of the osteotomy is a classic rookie mistake, your contrangle head is touching the mesial tooth and that generates torque, torque generates rotation that gets the apex of the drill to go mesial, hence the angulated osteotomy. The simplest solution is to use the drill extender,that will allow you to see and drill without any contact, hence straight osteotomy.... No more problems

Hard to say not knowing the exact angulation of adjacent roots. Even with a surgical guide you might go wrong. Safest way is to use a CT based surgical guide or as mentioned before using guide pin and PA x-ray.

I would suggest to do radiograph when you drill first 5 mm in the bone.Its easier to change the angle at this stage rather than going for full length of osteotomy.

Radiograph to be done after drilling with pilot drill and checking with depth gauge.

Rand, thank you for your comments on the MD Guide pilot drill and surgical guide combined into one. We have had great feedback on the product and it absolutely is the easiest and most cost effective instrument on the market to assist with properly spacing implants. Golden Dental Solutions