The Little PDF of Implant Wisdom

Implant Ninja’s
Little PDF of Implant

Wisdom
Everything you really need to know

Part 1:
Super Simple
Implant Treatment Planning
www.implantninja.com 2
Introduction
Treatment planning single implant procedures can be quite simple.
Unfortunately it’s not usually explained simply, so we end up thinking that

there is some mystical power that goes into it. That we need to know more.
That it cannot really be that simple.
Well, the truth is, that it is.
Sure, some implant topics are complicated but single implants where there
is enough bone and low risk factors, is a piece of cake.
Watch, I’ll show you in this little ebook download.
5 steps
I’m going to take you through 5 levels of questioning that you can use to
pretty much plan any single implant case.
No fluff.
Let’s get er done.
#1 Bone Height
www.implantninja.com
“QUESTION: How
much bone height do
i need?”*
Answer: 8 & 10mm
www.implantninja.com *(that’s what she said)

Why 8 & 10?
To be on the safe side, 8mm of bone height is a

good minimum requirement. As long as you have
8mm, you’re good.
EXCEPT at the posterior mandible. In the

posterior mandible, I look to look for 10mm
because we need to stay 2mm away from
superior border of the IA nerve canal.
So, we’re still just using 8mm of bone height as a

minimum, but we’re just trying to keep our 2mm
safety distance.
How does that height look? I know you don’t
know the exact measurements right now, but
you should try to get good at estimating heights
based off of adjacent teeth roots. This will help
you work-up the case quick fast.
See how deep this one is? Totally unnecessary. A shorter implant could
have been placed. 8mm in length is sufficient.
Now THAT’S better. We had only 8mm in length. I placed an 8mm
implant and allowed it to engage the floor of the sinus.
Can I go shorter?
Shorter implants can sometimes be a good alternative. I’m not saying it’s
not an option. It is ALWAYS possible to make an argument for this or that
exception.
The point of this guide is to give you some solid rules of thumb that will
help you land in a predictable and safe zone. Sure, you can push the
envelope if you want. But use these basics as a safety reference and then
use your own judgement.
And, yes, I do use the occasional 6mm implant. If for some reason I can’t
or don’t want to elevate the sinus.
But what if...
“You don’t have
enough bone.” *

13
Your options if you don’t have
“You don’t have sufficient bone height:
enough bone.” *
1. If you’re in the Posterior Maxilla: sinus lift
(That’s pretty predictable and easy to recommend)
2. If you’re in the Posterior Mandible: vertical

augmentation.
3. If you’re in an Anterior tooth site: vertical

augmentation
Options #2 and 3 are less predictable. Vertical bone

augmentation is not easy. You should recommend
alternatives (bridge & partial) to implant therapy in
this scenario as well.
14
#2 Mesio-Distal Space
“QUESTION: how
much mesio-distal
space do i need?
Answer: 7mm
You’ll want to measure this at
the adjacent teeth crowns from
contact to contact.
But you’ll also need to measure

the distance from root to root.
This one is a little tricky
because there is definitely
enough bone between the root
and the implant but it is a bit
narrow between the crown and
the adjacent tooth.
Remember 7mm is still your

minimum.Stick to the rules of
thumb and you’ll have an
easier time planning these.
But what if...
“You don’t have
enough mesio-distal
space.”

7mm of mesiodistal space:
1) Refer to ortho to open up the

space or…
2) You can lightly adjust the

adjacent (enameloplasty) teeth
crowns if its a minor adjustment
Exceptions:
Its okay to have 6mm of
mesio-distal space for Maxillary
laterals, mandibular centrals and
laterals.
For these sites you can use

3mm diameter implants.
#3 Bucco-lingual width
“QUESTION: how
wide should a one’s
bone be? Just
wondering…”*
Answer: 7mm
www.implantninja.com *(that’s what he said)

When it comes to bucco-lingual
width, looks and even “feels”
can be deceiving.
Always anticipate there is less

bone than it feels like there is.
A cone beam will give you the

most accurate read. But to be
an implant ninja, learn to use
your thumb and index finger to
be a good predictor of width.
Bone Sounding
There are “bone sounding”

instruments you can use to
pierce the gums and measure
how wide the ridge is.
Of course, you’ll have to get

your patients numb before
doing this.
Bone Sounding
You can also bone sound with

a perio probe. Although this is
really only useful to probe for
vertical height, not really that
useful for assessing width.
But what if...
“You don’t have
enough
bucco-lingual width.”

7mm of mesiodistal space:
1) Guided Bone Regeneration with

delayed implant placement or...
2) Ridge Split with immediate

implant placement
Exceptions:
It’s okay to have 6mm of
bucco-lingual width for Maxillary
laterals, mandibular centrals of
laterals.
For these sites you can use

3mm diameter implants.
Think that was too easy?
Alright cool guy, let’s take a look at a case.
Would you place implants

here on this patient?
They came in saying,

“I want implants here at my
canines.”
Let’s assume there is

enough height.
Looks easy right?
Not so fast pal...
See? This one was a trick question. I still have to share with you
the last measurement to look at when planning these cases.
#4 Crown Height Space
“QUESTION: how
much crown height
space do i need?”
Answer: 8-10mm
You need enough clearance so that you
can fit all of those components inside of
your implant crown. 8-10 is the perfect
amount of space for single crowns.
But bigger is not necessarily better.
For stresses applied like

this. (axially aka straight up
and down)
There is no difference in
stress distribution for
different crown heights.
Moraes, S et al 2013
Stresses applied like this
(non-axial aka oblique load) lead
to different stress distribution in
the different crown heights.
The stress concentration in

oblique load for 15mm crown is
almost double of a 10mm crown.
That can lead to:
- Screw Loosening
- Screw Fracture
- Abutment Fracture
Moraes, S et al 2013
In this case we essentially had NO crown height space. That
implant would have gone unrestored and the patient would
have been pretty upset to say the least...
But what if...
“You don’t have
enough crown height
space.”

at least 8mm of mesiodistal
space:
1) Refer to ortho to open up the
space or...
2) Adjust opposing tooth if it is just

a small adjustment
#5 Stable Occlusion
So, once upon a time…
I worked at an office that was super fast paced. (You know what i’m talking
about)
They sat a patient in front of me and quickly wanted me to place an implant

at #11 because he had already accepted treatment and paid (before ever
seeing me).
The treatment planning coordinator rattled off some things about insurance
and patient is taking a vacation or whatever. (I hate it when these external
factors confuse the true clinical decisions…)
Anyhow, I quickly assessed the site and decided that there was
enough bone height and width and mesiodistal space.
So I proceeded to place the implant in 20 minutes like a boss.
The implant healed no problem and I was worry free for 4 months.
The patient came back to restore the implant and easily took
impressions.
That’s when the trouble started...
The patient came back with the abutment/crown broken in
these two pieces.
What happened?
This is the crown
Well, this what what the patient looked like. I had made
Here’s a closer look.
It is the ONLY tooth that is occluding in his entire mouth!!

OMG I can’t believe that happened! It was a hell of a
restorative appointment. But that’s what I get for not being
thorough.
Some of the best advice I got was from an old prosthodontist
was,
“Hurry up and slow down.”
Emphasizing that when you’re trying to do things well, doing

them slow ends up being faster than doing them in a rush
and having to redo your work.
...anyway to have a successful outcome,
you must first properly assess the remaining dentition.
Is there a stable occlusion that will allow your implant to

succeed? That is a definite prerequisite for placing an
implant.
So here’s a list of all of the items we covered. Keep them top
of mind when treatment planning implants and you’ll avoid a
lot of potential issues!!
#1 Bone height: 8 & 10mm

#2 Mesio-distal space: 7mm
#3 bucco-lingual width: 7mm
#4 Crown height space: 8-10mm
#5 Stable occlusion!
Part 2: Implant Surgery
Now, I could spend a lot of effort trying to
explain implant surgery to you with pictures.
But pictures don’t do it justice.
Lucky for you, my
Youtube Channel
exists.
For play-by-play for

surgical videos, go Click Me!
check out my channel,
starting with this video.
Question: Should I
take x rays during
the surgery?
Answer: Hell yes.
I thought I was a cool guy for a

while until I saw some x rays on
my own implants that looked
eerily close to what you see
here.
Don’t be a cool. Be safe.
www.implantninja.com Photo credit: @nehavaish15 54

Alright, so the implant is
placed…. now what?
It’s time to restore!!
Not so fast, spongebob.
Make sure you waited long enough

before you mess around with the
implant...
How long is “long enough”
you ask?
Here’s a good rule of thumb:
In the Mandible, wait 3

months before restoring.
In the Maxilla, wait 4 months

before restoring.
If the patient is a smoker or diabetic, or

has a wound healing disorder, ADD an
extra 2 months.
After the waiting period, you’re ready to restore!
www.implantninja.com ...so now what?

Part 3: Uncovery & Impressions
If your site looks something like
THIS...
(See how it has the healing

abutments on the implants
already?)...you’re in luck!
It’s going to be a breeze to take

impressions on this.
I’ll walk you through this in slide

87 . If the site looks like this, skip
to that slide.
Okay, looking back on this, there
isn’t much keratinized tissue on
the buccal part of this implant
site.
That is a little troublesome

because the site will accumulate
a bit more bacteria and be harder
for the patient to clean.
(Basically, it’s not the end of the

world if you don’t have keratinized
tissue here but it’s certainly better for
long term maintenance & health.)
But what if you can’t see the implant?
damn son...
You’re going to have to do some digging
and “uncover” the implant.
(this is often called a “phase 2” appointment.
Not to worry, let me help you out.

Here are the possible scenarios:
Uncovery Scenarios: Difficulty level
1. Cover screw is showing through the Noob

gums
Intermediate
2. Everything is fully buried
3. Everything is fully buried and bone has grown over the

cover screw
www.implantninja.com LEGENDARY
Let’s look at the first scenario:
Cover screw is showing through the gums
The cover screw can be seen through the tissue so you know
exactly where the implant is. This is pretty easy peasy...lemon
squeezie.
Word of caution: if the cover screw is showing through the tissue,

maybe there is some bone loss around the implant. Make sure to
take an x ray to check.
In these cases where you can
actually see the cover screw,
you can simply apply local
anesthesia and cut a little
window with a 15 Blade.
This is what a cover screw

looks like, just FYI...
After removing the tissue, and
the cover screw, place a healing
abutment onto the implant.
This is what a healing

abutment looks like, just
FYI...
Sometimes you can remove the
cover screw without doing any
cutting.
But it’s usually better to cut a

little to release the tissue
because the cover screw will
often stay stuck under the tissue
if you don’t do any cutting.
Some minor tissue removal is
often all it takes to access the
cover screw. This picture isn’t
pretty but it got the job done...
You can also use a narrow

platform tissue punch to
remove the tissue quickly.
Let’s look at the second scenario:
Everything is fully buried
In these, the gingiva has grown over the implant and you have
to find it. Sure, you have to cut the gums and reflect a small
flap, but it’s not very difficult to do.
Finding the Implant Site
I like to first get the patient numb and then probe

around into the tissue with a perio probe. You
can often feel the hardness of the cover screw
so you’ll know where to cut.
If you’re 100% sure about where the implant is,

you can use a tissue punch.
(But keep in mind, using a tissue punch removes some
keratinized tissue we discussed!!)
You basically just have to flap
where the site is and you’ll find
the cover screw of the implant
peeking at you.
Again, this is what a cover

screw looks like, just FYI...
Then you take the cover screw
off, put a sterilized healing
abutment on and then wait 2
weeks before taking the final
impressions.
Again this is what a

healing abutment looks
like, just FYI...
Now, let’s look at the final scenario
Everything is Fully Buried and bone has

grown over your implant.
Efffff...
Difficulty level??
(Terry Crews level extreme)
OK OK in all seriousness, it’s not THAT hard.
It’s still totally doable.*
You just have to have the right tools and have enough time
and patience to remove some of the bone that’s covering
the implant.
www.implantninja.com *Michael Scott reference here ;)

I’ll show you an example...
First, give some anesthetic at the site where the implant was
placed. I use septocaine and I inject all along the ridge.
By the way, I have another

video on this on this on
youtube. Check it out
here!
Then I make a crestal incision from one adjacent tooth to the
other. There are a few different designs for flaps. In this case
I am going all the way to the adjacent teeth and then...
I am cutting into the sulci of the teeth. You can also choose to
do a papilla sparing design to help preserve the papillae. I
didn’t have much mesio-distal space here and I didnt want to
cut the adjacent teeth’s papilla to thin and risk loosing it.
Then I reflect the flap to the buccal. I do this carefully. The
more conservative I am with the tissue, the less I disrupt the
vasculature and less changes I make to the papilla.
Sometimes bone grows over the implant. My go-to, is to use
the periosteal elevator to scrape some of that bone off from
the cover screw. However, in this case, there was too much
bone overgrowth so...
I had to resort to using the handpiece to carefully remove
some of the bone that was blocking the cover screw. You
have to be SUPER GENTLE here as you can damage the
implant platform. You can also use a smaller bur on an
electric handpiece to have better control.
Once the cover screw has been removed, make sure you can
secure a healing abutment on the implant.
You have to make sure the healing abutment can go all

the way down because if the healing abutment does not
seat properly, that means your impression coping might not
seat properly when it’s time for impressions.
Okay, so now your implant
is placed (and uncovered)
and it’s ready to restore!
This is totally you...
I’m ready,
Impressions!
Taking an Impression
You might be wondering, do I take open tray impressions
or closed tray? Does it even matter? What am I doing with
my life? Errr, getting off topic there...
Closed Tray Open Tray
vs
89
Which one is better?
For single units, in terms of accuracy it does not matter whether you use open
or closed tray techniques. So use what is most convenient--that’s usually a closed
tray impression technique.
For multiple units, I like to use open tray because I can splint the impression
copings together with light-cured triad, locking them in place.
For patients with small openings, use closed tray impression copings all the
way!
For divergent implants, open tray can be easier to dislodge from the patient’s
mouth.
That said, no impression coping will save you from this mess. For crazy
divergence, don’t use impression copings. Instead, order NON-ENGAGING
titanium temporary cylinders. Life saver right there. This tip alone is worth $2,000.
Lucky you... You’ll thank me later :)
Another pearl that will save you one day…
(This tip is $$$)
For patients with small openings it can be nearly impossible to deliver a screw
retained implant crown for a molar.
I’ve even had patients referred to me just to deliver other people’s crowns LOL
If your implant driver and wrench don’t fit in the mouth, just use your implant
handpiece with the little latch attachment insertion tool.
For a step-by-step
walkthrough of open tray
impressions. Click this
picture and watch the youtube
video I made for you.
Closed tray impressions, on

the other hand are pretty darn
easy. I think you’ll have no
problem with those at all.
Okay, so lets recap:
implant DONE
uncovery DONEzo
Impression Nailed it!
Now to deliver this shiznit.
Part 4: Delivery
Delivering a Screw Retained Crown
Removing healing abutment
Some clinicians tap on the
healing abutment with the back of
an intraoral mirror. The sound it
makes can often help you
determine if the implant is stable.
It’s a quick and dirty way to
assess.
Also, this patient has a huge

healing abutment. This makes it
convenient to restore but can also
squish the papilla.
This is what the mirror handle test sounds like. Check out this video to compare what
a problem implant sounds like. Can you tell which one is an issue?
A non integrated implant or a loose abutment on that implant will sound like a dull thud.
Irrigating with Chlorhexidine
Once the healing abutment is
removed, I like to irrigate the
internal aspect of the implant
with chlorhexidine. There is
some evidence to show delayed
healing of wounds with
Chlorhexidine now, so be careful
what you use it for.
Apply topical anesthetic
I apply topical anesthetic to the tissue
just in case my crown will squish the
tissue and cause pain while inserting.
If you had taken some time to mold the

tissue prior to restoration, pain should
not be much of an issue right now, but
let’s just pretend that you did not prep
the emergence profile with a custom
healing abutment or temporary.
Check Seating
Sometimes screw retained
crowns bind on the mesial and
distal aspects. At this point, I
like to make sure the crown
looks properly seated and that
it is not binding anywhere.
Check your contacts
Use floss to check your
contacts.If one contact is too
tight, it could mean that the
abutment is not properly
seated. Adjust as needed to get
it to seat fully.
This is what the crown looks
like before going in. It is a
single piece screw retained
crown. The laboratory cements
the entire crown portion onto a
small titanium base to create
this prosthesis.
Model
This is what the model looks
like. I actually don’t like for the
adjacent teeth to be filled with
resin, like is shown here.
Instead, I like it to be with
regular old die stone--or
digital! :) but oh well.
After you place the crown, be sure to take an x ray so you can confirm that it
is properly seated. Make sure there is no shadow at the junction!
Check occlusion
At this point, get your occlusion
so that it is slightly lighter than
the occlusion on the adjacent
teeth. You will adjust it again
after you fully torque it down.
Torque
If its properly seated, proximal
contacts are good, and
occlusion is good, make sure
to polish the areas you
adjusted and then you can go
ahead and torque it down.
Torque
Torque values vary depending
on manufacturer
recommendation but are
typically 30-35 Ncm.
Retorquing
Literature suggests that you should re-torque the screw
after waiting some time. The amount of time is not nailed
down exactly. But 10 minutes is a safe bet. 10 min after
the initial torque, go ahead and torque that screw one
more time.
Re-check occlusion
Even though you’ve already
adjusted occlusion, check
occlusion again once you have
torqued the crown. You’ll want
to relieve it so that the
occlusion on the implant is
minimal. When the patient
bites down lightly into MI there
should be no occlusion on the
crown.
Plug the Access
Plug the access hole with a
barrier so that the screw head
does not get damaged if you
ever have to re-access the
hole. I like to use teflon tape. I
used a cotton pellet in this
picture.
Leave room for composite
Make sure to push the
plugging material down far
enough so that you have
enough room for composite to
bind and not fall out. I like to
leave 3mm of room at least.
Place composite
Place composite into access
hole and make sure it does not
interfere with occlusion.
Check occlusion again
Even though you did your
best, the composite is still
probably interfering with the
occlusion. You also want to
check excursive
movements--like when the
patient grinds to the right and
left. Remove those and relieve
any added contacts from the
composite.
Done!
Polish the composite surface
and...your done!
Delivering a Cement Retained Crown
Put the abutment onto the implant. You
have to gently feel it and make sure it
engages into the implant before you go
and tighten it down. This is a learned feel.
It is super important that you make sure it
fully seats.
After its in position, go ahead and take an x

ray to verify that the connection is flush.
Place the crown onto the abutment. See if
the incisal edges match up to where you
wanted them. Does it seem to be seating
properly just at-a-glance?
If so, you’re likely on the right track.
Go ahead and check the crown fit as if it

was a natural tooth. Here you see me
checking contacts.
You didn’t forget the steps to seating a
crown did you?
Let’s refresh anyway:
● Check the contacts!
● Assess marginal fit. In my opinion, if it’s seated at

the margin, it’s fitting properly, right?
● Check occlusion! For single implant crowns,

surrounded by adjacent natural and healthy teeth,
let’s leave the implant just slightly out of occlusion.
The nice thing about implants is that the
margins should be perfect because the crowns
are milled precisely to fit the abutment and you
can check this out of the mouth.
Anyway, you do want to make sure that your

crown seats fully. So if the contacts are good,
take a look at the margin.
It’s easiest to assess at the lingual side. You can

use a perio probe to feel the margin there
because the tissue is a little more rigid and the
margin can be a little more superficial on the
lingual.
Now that you’ve:
- verified radiographically that the abutment is
seated fully
- You’ve tried on the crown and it seems to
line up well at the incisal edges and has a
reasonable occlusion (you didn’t do your
final occlusion check or any adjustments to
occlusion at this point.)
It’s time to torque the abutment.
I like to place the little driver bit onto the

screwhead by itself first. This just seems
to be easier than trying to engage it while it’s
attached to that whole big torque wrench
contraption.
After I engage the screwhead with my
fingers, I attach the wrench onto the the
little driver bit.
Most implant systems have you torque the abutment screw down to about 30 Ncm.
Then I’ll go ahead and place the
crown on the abutment and check
the occlusion with articulating
paper.
If there are healthy adjacent teeth

and the occlusion is stable, I want
to leave this implant crown slightly
out of occlusion.
So at this point, I’m going to adjust
this to eliminate the marks.
The “centric occlusion” marks are the

ones that the patient makes when
you tell the patient to “tap tap tap”
Let’s relieve these.
The “eccentric marks” are the blue

marks you get when you have your
patient grind side to side. You want to
completely eliminate these contacts
so that there is no chance they are
putting these eccentric forces on the
implant.
Place some teflon (if you don’t have teflon, use cotton pellets) inside the access hole so
that you don’t get any cement inside accidentally.
I push it in a little so that I am 100% sure that it is not messing with my
occlusion.
To help you NOT overfill your crown
with cement, you can use this little
trick.
Fill your crown with light body PVS

and let it overflow.
Then I mix the cement or just use the little extrusion tip.
I like to use Fuji Cem. I like that it’s radiopaque!
I fill the crown with cement and
then I plug the little PVS thing
we made into it and it extrudes
the cement. Don’t push TOO
hard or else you might remove
almost all of the cement.
But for implant crowns, a little

goes a long way!
Then I seat the crown and hold it as it
sets. I then check all the margins with an
implant curette.
There are a variety of implant curettes.

The plastic ones use to be
recommended but I really don’t feel they
work well.
I used a titanium curette here and it

works well at the margin but it can
scratch up the crown. Notice at the
cervical aspect that I accidentally
scratched the crown here.
Lastly, recheck your occlusion! Doing most of your adjustment beforehand is
best because then you can polish it outside of the mouth too. But in this case,
I saw that the occlusion was close and I just decided to do the adjustment in
the mouth after I cemented it. It’s a faster way to do it, but less ideal. I used a
zirconium polishing bur after this to get it smooth.
There are a ton of different types of adjustment burs out there. This is the one
that I used. Use whatever you use for your natural-tooth crowns.
Question: What if my
screw strips?
“What if yo
momma strips?
Answer (to Dwight’s question):
I like to use a screw removal kit. It’s
saved my life a couple times. I show how
to use it in this video.
Part 5: Other
Important Shiznit
Absolute Contraindications
IV Bisphosphonates
Oral Bisphosphonates sometimes pose little
risk, but IV is no joke. This is a deal breaker
for me.
Radiation Therapy
Above 65Gy there is a significant risk for ORN. Trust me you don’t
want ORN. But even at 55Gy I still refer out to an oral surgeon, I like
to keep it predictable for myself. At 55 Gy, the implant is most held in
mechanically NOT by osseointegration.
Any Uncontrolled Medical Condition

I know this is vague, but I ask patients if they’ve had any
hospital visits in the last 2 years. Any condition must be
diagnosed and monitored/treated by the appropriate
physician. Bottom line: If patients are not on top of their
healthcare, I can’t help them.
- Bisphosphonates
- FOSAMAX (Alendronate)
- Zolendronic acid (Reclast or Zometa)
- Didronel
Here’s a list of RED FLAG
- Boniva MEDS I have laminated and
- Aclasta use to screen my patients.
- Atelvia
- Actonel
- Aredia
- Binosto
- Skelid
- Antiresorptive agents:
- Denosumab
- Xgeva
- Prolia
- Antiangiogenic agent used in cancer chemotherapy
- Sunitinib (Sutent)
- Bevacizumab (Avastin)
- Corticosteroid
- Long-term Prednisone with fosamax
Here’s a list of some of the frequently
prescribed meds...
Prescriptions
- Amoxicillin
- 500 mg tabs
- Disp: 18 tabs
- 2 g 1 hour prior to surgery
- 1 g 6 hours initial dose
- 1 tab tid for 3 days
Prescriptions
- Clindamycin (If allergic to amoxicillin or if swelling/pain worsens after 4 days)

- 300 mg tabs
- Disp: 12 tabs
- Take 2 tabs 1 hour prior to procedure
- Take 1 tab 6 hours after
- Take 1 tab tid for 3 days
Prescriptions
Pain Meds
- Tylenol #3 (acetaminophen with codeine)

- Take 1 tab qh6 prn pain
Anxiety
- Rx: Valium 5 mg
- Disp: 1
- Sig: Take 1 tab 1 hour prior to procedure
- * No driving within 8 hours of taking Valium*
That’s all for now!
Thanks for taking the time to look this over my

friend. I truly think that this will be helpful for
you to look back on throughout your implant
learning journey.
The warmest regards from my family to yours

:)
Cheers!
Ivan Chicchon
PS: If you’re looking to learn to place dental implants or even full
arch dental implants, I run an educational program called
Implant Ninja. It’s pretty ass kicking. I know this implant stuff can
be intimidating, but it really can be broken down to be super
intuitive and easy.
Feel free to give us a shout at implantninja@gmail.com
I’m looking forward to being in touch sometime!
www.ImplantNinja.com
147

The Little PDF of Implant Wisdom

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The Little PDF of Implant Wisdom

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Implant Ninja’s

Little PDF of Implant

Everything you really need to know

Unfortunately it’s not usually explained simply, so we end up thinking that

Well, the truth is, that it is.

Watch, I’ll show you in this little ebook download.

Let’s get er done.

Answer: 8 & 10mm

www.implantninja.com *(that’s what she said)

To be on the safe side, 8mm of bone height is a

EXCEPT at the posterior mandible. In the

So, we’re still just using 8mm of bone height as a

www.implantninja.com *(that’s what she said)

(That’s pretty predictable and easy to recommend)

2. If you’re in the Posterior Mandible: vertical

3. If you’re in an Anterior tooth site: vertical

Options #2 and 3 are less predictable. Vertical bone

But you’ll also need to measure

Remember 7mm is still your

Your options if you don’t have

1) Refer to ortho to open up the

2) You can lightly adjust the

For these sites you can use

www.implantninja.com *(that’s what he said)

Always anticipate there is less

A cone beam will give you the

There are “bone sounding”

Of course, you’ll have to get

You can also bone sound with

Your options if you don’t have

1) Guided Bone Regeneration with

2) Ridge Split with immediate

For these sites you can use

Would you place implants

They came in saying,

Let’s assume there is

Looks easy right?

For stresses applied like

The stress concentration in

That can lead to:

Your options if you don’t have

2) Adjust opposing tooth if it is just

They sat a patient in front of me and quickly wanted me to place an implant

So I proceeded to place the implant in 20 minutes like a boss.

That’s when the trouble started...

It is the ONLY tooth that is occluding in his entire mouth!!

“Hurry up and slow down.”

Emphasizing that when you’re trying to do things well, doing

Is there a stable occlusion that will allow your implant to

#1 Bone height: 8 & 10mm

But pictures don’t do it justice.

For play-by-play for

I thought I was a cool guy for a

Don’t be a cool. Be safe.

www.implantninja.com Photo credit: @nehavaish15 54

Make sure you waited long enough

In the Mandible, wait 3

In the Maxilla, wait 4 months