In this video, Dr. Fields shows and explains the rationale behind his decisions when renewing this patient's smile.

Full Case Summary: We removed 5 teeth: teeth #12, 13, 14,15, and 18. After three months of healing prior to implant placement, we developed an implant strategy that saved this patient a whole lot of money while giving him a high-quality result. Given his occlusion and the nice bone height and width available, we replaced only 2 of these teeth rather than all 5, while providing what should be a lifelong implant foundation for his occlusion. Dental implant tooth replacement doesn’t have to be a ridiculously expensive treatment option, even as with this patient if it is their only reasonable option. So, this is a great strategy to provide cost-effective implant treatment when conditions allow.

For this patient, we took the unusual step of placing a wide-diameter implant in the premolar position as well as in the molar position. Note: we are treating this as if the patient had a first premolar extraction for orthodontic purposes, and our intent is to restore these as a second premolar and a first molar, for maximum occlusal chewing surface with just two implants. Typically, 4mm diameter implants are much better suited for the replacement of premolars, and often a wider implant will not safely fit between adjacent teeth. Here, however, we had no distal tooth, so we had the latitude to adjust the position of the distal implant according to the spacing needs of the premolar implant.

A look at the CTs makes it clear that we have enough bone for a 5mm diameter implant in both of our desired implant positions. 10mm length implants are plenty safe without unnecessarily challenging the maxillary sinus. So, both implants selected are 5mm x 10mm Z5TL Z-Systems all zirconia implants. Since these are tissue-level implants, both were placed at the tissue level, not exceeding 35Ncm of implant insertion torque. If additional torque is required for placement, the implant should instead be removed and the implant osteotomy modified to accommodate a more moderate insertion torque at the proper implant placement level. Since this patient also had plenty of attached gingiva, we made the decision to go with a more atraumatic procedure and place these implants using a flapless technique. I would consider a flapless implant technique a much more advanced and difficult technique than one in which a flap is reflected. So this should not be a default procedure for doctors uncomfortable incising and reflecting proper flaps or unfamiliar with the proper suturing technique.