Placing Tapered Dental Implant: What’s the Best Approach?

While using a tapered implant, you don't need to widen the osteotomy site as you need the wedging effect of this implant for better primary stability through bone expansion According to manufacturer of this implants, you just use a drill equal or little bit smaller than the diameter of the apex or apical 3rd of the implant For example, I am using a tapered Microdent implant with an apex diameter 2.00 mm So I just drill full length with a 1.8 mm drill and then insert the implant.. This is applicable in soft bone , but in harder bone , the manufacturer will provide you with wider tapered drill or bone expanders prior to osteotomy site preparation . Tapered implants is my favorite

Dear Dr. C Dr. Halim gave you good advise on how to place tapered implants.You obviously do not have a wedging effect as the hole you created is too large. From what you describe, the implant is simply resting in the osteotomy, with particulate grafting material around it. If left undesturbed for six months,with the gingival soft tissue closed; no possibility of any pressure on it, and no infection.... then you probably have a 50:50 chance of good success. If it fails, you will have to clean out the osteotomy, graft and wait six months before you reprepare the site. In future select drills that are specific for the shape of the implant, and a slightly smaller diameter so that you will obtain that initial stability. In the maxilla, Osteotomes that are tapered shape are excellent to expand the bone and fit the implant very snugly. Everyone has learning experiences as they start something new.... do not feel badly, and good luck.

Not all tapered implants have the same insertion protocol and one should carefully follow the manufacturers guidelines. For example, some tapered implants aka. Zimmer, Implant Direct, place a tapered bodied implant into a PARALLEL walled osteotomy. These implants, as do all, require a slightly undersized osteotomy so that there is compression on the wall of the osteotomy. In the case of a tapered into a straight walled osteotomy, the compression increases more at the coronal aspect as the implant is turned home. Other tapered implants such as the Nobel Replace utilize a TAPERED osteotomy. As this implant is turned home the compression increases at the apex due to the wedging effect of the tapered implant going into the tapered tip of the osteotomy. Tapered into tapered induces quite a bit more bone compression than does tapered into parallel and it does require some experience to get it right. The bottom line is that tapered implants in general should be able to provide a greater degree of primary fixation at insertion. This is of benefit in soft bone or where immediate implants are placed. In hard mandibular bone these are a little more tricky to place. There is definitely a place for both tapered implants and parallel walled implants and most manufacturers recognizing this fact, make both types.

Dear Dr.C, There are a couple of things that need to be understood here.Firstly you have not mentioned whether the osteotomy was done in maxilla or mandible.It is difficult for me to understand your statement that" I made the osteotomy too large" ....did you try to correct the angulation of placement in succesive drills to get the parallelism right? that can make the osteotomy large. Primary stability is vital as it is a fair indicator of good BIC-bone to implant contact.. Higher BIC= better osseointegration. If you did not achieve primary stability...avoid loading direct/indirect to the smallest degree. Delay the final loading of implant well beyond the conventional time frame depending on maxilla or mandible. In most of the surface treated implants of today Osseointegration is facilitated even in compromised cases such as these..I've had a few of them myself. Dont worry take it as a learning expereince..All the best.

Dear Dr.C You dont need primary stability. As far as implant fixture in place and you have enough blood supply you should be ok. Just suture it over. If you dont have primary closure the blood clot inside you osteotomy between the implant and wall will generate bone for you. However if you have primary closure so by prevent sofe tissue grow in you better gaft asn place membrane over. Inform pt not touch area for a month you will have good integration. Good Luck

Eric, I beg to differ. I have pulled this off just the way you described. However, primary stability is a goal and most important.

Dear Dr. C The first aim ın ımplant placement is primary sability .If the osteotomy site is too large there are three ways to go. First close up the soft tissue and wait for the blood clot to change in to bone.This takes six months for the upper jaw and three months for the lower jaw. Second fill up the osteotomy site with a mixture of blood 1/2 otogenous bone 1/4 mıneralise 1/4 nondemineralise bone chips cover the site with a membrane and sture the soft tissue wait for the bone formation for at least for three months. Third use a larger and a bıt longer implant. Whatever way you choose please keep the patient under antibiotic coverage for a week.