Perforation of natural roots while drilling for implant placement l Live Implants Courses

MIAMI - April 13, 2014 - PRLog -- Imagine you are placing an implant, you have made all your measurements for angulation and spacing, your pilot drill looks in the correct position clinically and then you take an X-ray only to see that you are about to perforate the curved root of the adjacent tooth

Incredible but true this is more common than you would expect, just ask your local endodontist and you will be surprised many root canal treatments are performed as a direct result of root perforations while drilling for implants.

This drill appears to be in the correct position bucco-lingual and mesiodistal… correct? initial inspection clinically will lead you to think that perhaps the drill needs to be tilted distally but watch what happens when periapical film is taken.

The pilot drill was inserted to full length and a periapical X-ray revealed that the canine root was almost perforated Many clinicians forget to take check film after the pilot drill is inserted to length, this can lead to serious mistakes. It helps if you outline the roots of adjacent teeth to visualize the needed angulation, this is clear when you observe this digital X-ray.

How can you avoid this type of problem? we have found a proven method to correct or avoid this problem is to lean the pilot drill against the distal marginal ridge of the canine at a 30* angle from the center of the guiding tooth. Don’t overcompensate by placing the pilot at 45* since this will cause perforation of the distal adjacent tooth.

Yes, I recognize that this this technique seems to be strange and ineffective…but it really works. We have been using it for many years training Dentists how to avoid perforating curved roots commonly found in the maxillary and mandibular cuspid and bi-cuspid areas. These are the teeth more susceptible to perforation due to their anatomical positioning and curved roots.

If you follow this “crazy rule” of angulation, you will consistently see results similar to our final X-ray where the fixture is placed equi-distant from the adjacent teeth and it’s aligned with the long axis of what will be the final restoration.

Dr Virgil Mongalo has been practicing implant dentistry in South Florida since 1991. Has placed and restored over 12,000 implants in private practice and dedicates half of his professional time to teaching Dentists how to master implant surgeries. Author and international speaker. Clinical director of Live Implant training courses. Can be contacted at Liveimplants.com.

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http://liveimplanttraining.com/dental-implant-courses/liv...